HEALTH SUPPORT SYSTEMS

6.1. LOCAL HEALTH SYSTEMS

The implementation of the Local Government Code of 1991 resulted in the devolution of health services to
local government units (LGUs) which included among others the provision, management and maintenance of
health services at different levels of LGUs. What used to be a centralized national health system became
many independent local health systems. After more than seventeen (17) years of devolution, improvements in
health status of populations show marked variations across LGUs. Variations in health status were associated
with variations in the performance of health care providers and health care professionals in localities.

In spite of the devolution, the DOH is still the institutional steward of the nation’s health system. As the
prime national health agency, it has the authority to provide coherence and direction in enhancing operational
effectiveness of local health systems towards improved health status in localities. The DOH encouraged
provinces and their component municipalities and cities to plan together and develop a five (5) year Province-
wide Investment Plan for Health (PIPH). This medium-term health plan became the key instrument that
DOH utilized to forge partnership with the LGUs towards improved health outcomes, more equitable
financing of health care and greater public satisfaction. As an approach to health reforms, the PIPH
represents all the stakeholders’ interests since all LGU officials and health stakeholders plan together to
improve the health system of the province.

As of 2010, 80 provinces and 8 cities have completed their five (5) year investment plans for health
(PIPH/CIPH) including their annual operational plans (AOP) (Department of Health, 1980-2010). These
Plans undergo a review by a Joint Appraisal Committee (JAC) prior to DOH approval. The signing of a
Memorandum of Agreement (MOA) between DOH and the LGU to support local health reform
implementation triggers a series of inter-related events to facilitate the annual operationalization of the
PIPH/CIPH: (1) release of start-up funds to jumpstart plan implementation ; (2) review and approval of the
AOP; (3) forging of an annual DOH-LGU Service Level Agreement (SLA) which details DOH and health
partner commitments as contained in the AOP ; (4) release of the DOH annual fixed allocation and other
support; and (5) release of a performance-based incentive for the previous year achievement of specific
indicators from the Local Government Unit (LGU) Scorecard.

The LGU Scorecard is the tool institutionalized by the DOH to track and assess the overall outcome of
implementing health reforms in the province-wide health system (PWHS). It measures intermediate
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outcomes of access, quality and efficiency including major reform outputs based on the Programs, Projects
and Activities (PPAs) of the DOH. The LGU Scorecard thus provides a composite performance assessment
of the efforts of various stakeholders within the PWHS.

Over time, a reformed PWHS will progressively achieve the national targets for the intermediate outcome
indicators and show all excellent rating (greens) in the LGU Scorecard. It will ultimately exhibit no
performance disparity across all its component municipalities/cities and inter-local health zones (ILHZs).
The goal for 2016 is to reduce the disparity of performance, particularly for the poor, among local health
systems (LHS). Local health development will be supported by building systems for evidence-based policies,
decision making and accountability mechanisms to strengthen local health authority, expand their partner and
support networks, and improve client-centered care and community participation adopting Primary Health
Care (PHC) principles in the context of Universal Health Care.

NATIONAL OBJECTIVES FOR 2011-2016

OVERALL GOAL: Reduce performance disparity among LGUs and vulnerable groups in
the country.

Data
Strategic Objective Indicator Latest Baseline 2016 Targets
Source
% Local health systems DOH
All PWHS and
with PIPH/CIPH Program
HUCs/ICCs is engaged
Report
in sectoral development
1. PWHS 100
prioritizing the poor, 100
2. HUC 24*
over a medium term 100
3. ICC 0
period 100
(2010)
% ILHZ that achieved DOH CHD
functionality in domain of reports
75% ILHZ
:public health protection, Baseline data for
Functional ILHZs that achieve 3
access to quality clinical ILHZs being
provide public health domains of
care and completed
protection, access to functionality
efficient management of
quality clinical care and
resources
efficient management of
% of GIDA DOH CHD/
resources are established
municipalities/ barangays Program
covered with a standard Reports or TBD 50
service delivery or Survey
financing alternative
DOH CHD
Local health capacity to % LGUs with excellent
/ Program 32
reduce disparity among (green) performance rating 80
Reports or (2009)
LGUs is strengthened in LGU scorecard
Survey
Service delivery systems % ILHZ with public DOH CHD
based on principles of private partnerships / Program
TBD 50
PHC, with public private Reports
partnerships, client % ILHZ with effective
centered care, and consumer participation
TBD 100
community participation systems
is improved
*computed at 8 out of 143 HUCs

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STRATEGIES FOR 2011-2016

 Utilize the approved PIPH/CIPH and AOP to provide fund support and or technical assistance to
LGUs to ensure health reform implementation in localities.
 Strengthen inter-LGU coordination in health operations through improved functionality of ILHZs.
 Ensure access and availability of quality health care sensitive and responsive to the health needs of
communities in GIDAs.
 Maximize PPP in health to improve access to quality health care, increase effectiveness and efficiency
in the delivery of services and enhance equity in the distribution of available resources.
 Improve consumer participation and ensure greater client participation in improving the health care
delivery system through: (1) establishing a consumer-centered feedback mechanism; (2) increasing
the poor’s purchasing power; (3) providing health information (4) supporting consumers to co-
produce or co-finance health services; and (5) Involving consumers in the policy and decision-
making process, as well as in management.
 Make optimal use of the following tools to track LGU performance: LGU scorecard, CHD
scorecard, Urban Health Equity Assessment & Response Tool and ILHZ functionality assessment
tool.

6.2. HEALTH INFORMATION SYSTEM

The problems of completeness, accuracy, timeliness and access to health data, and fragmentation of various
health information systems need to be addressed. Information systems that are managed separately by various
data producers bring about inaccessibility of quality data for decision making. Critical to harmonization,
interoperability and data exchange is an incessant multi-stakeholder collaboration among data producers and
users with shared agreements and unified efforts towards increasing availability, access and use of timely,
relevant and reliable health information. Use of available, relevant and cost effective information and
communication technologies (ICT) enhances the development of institutional networks and makes processes
and systems more efficient. It also enables health workers to do their work faster and better. The current
health sector enterprise architecture (EA) and the e-health strategic framework define the proper use and
function of ICT. Advancing in these areas will improve healthcare access, quality and efficiency of service
and higher level of client satisfaction and better safeguards for patient safety.

EA and e-health strategic framework have five priority focus areas in using ICT to support KP and these are
in various stages of development. These are defined as:

6.2.1. Enabling Structures and Resources

A rational and accountable eHealth agenda, with the essential legal and normative framework and
structures in place including standards, sustained financing, e-mature human resources, ICT
infrastructure and multi-agency collaborations.

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 6.2.2. Critical Application Systems

Increased efficiency of processes and systems in health care delivery and administration through new
and better application systems and processes for Philhealth claims, health records, disease
surveillance, drugs management and price monitoring, financial and procurement management and
other regulatory support services.

6.2.3. Philippine Health Information System (PHIS)

The PHIN shall work towards harmonization and integration of data sources and information
systems using acceptable data management standards and protocols and support initiatives that will
enhance health service statistics reporting especially from LGUs and the private sector. This will also
include improvements and scale-up programs for Information Systems (ISs) in health centers,
hospitals and other critical information and service delivery centers and support service groups.

6.2.4. Knowledge Management

Greater and better capacity for exchange and utilization of knowledge resources and systems
especially at the sub-national levels based on KM4Health framework. The latter encompasses health
research, knowledge translation, including knowledge sharing and exchange programs such as call
centers, e-library, best practices, Communities of Practice (CoPs) or K networks among others.

6.2.5. Telemedicine/mhealth

ICT capacities are maximized in reaching GIDAs, attaining MDGs and in collecting data and
disseminating health information to policy makers, provider and citizens. Patient monitoring and
tracking programs for MDGs such as maternal and neonatal events and TB treatment compliance,
and disaster response shall be given priority focus.

In the execution of the strategic goals and targets, the following valued principles shall be applied: a) client-
focused approach b) collaboration and partnerships and user involvement c) good governance and
performance through judicious and efficient use of resources, transparency, accountability d) ethics in
safeguarding privacy and confidentiality e) shared learning f) simple and cost effective technology application.

Long-term progress in the execution of the target activities will also help achieve the global commitment of
the country in the 58th World Health Assembly and the 2011-2016 Philippine Digital Strategy vision - “A
digitally empowered, innovative, globally competitive and prosperous society where everyone has reliable,
affordable and secure information access in the Philippines, a Government that practices accountability and

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 excellence to provide responsive online citizen-centered services, and a thriving knowledge economy through
public-private partnership”.

NATIONAL OBJECTIVES FOR 2011-2016

OVER-ALL GOAL:
Establish harmonized, quality, relevant and responsive e-health services to provide the
necessary tools, data, information and knowledge for evidence-based policy and program
development towards the provision of accessible, quality, affordable, efficient and safe
health services and attainment of better health outcomes for all Filipinos.

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective
DOH Information
Health Sector e-Health Systems Strategic
DOH Report 1 Road map
The eHealth Road map established Plan (ISSP) 2011-
infrastructure is 2013
functional at Health sector enterprise Draft Health
various levels of architecture (EA) and Sector EA ,
ICT4H e-health
health care delivery segment architecture for formulated by IMS
Strategy Report , Feb 4 segment EAs
PhilHealth, central office, and the ICT4H e-
2012
CHD, hospital and health health Strategy
center developed Report , Feb 2012
Basic ICT infrastructure
DOH ISSP, 2011-
establish in central office, 50% 70%
2013
regional and local level
Health Information
Systems standards/ ICT4H e-health
Increase efficiency Health Information Strategy Report , Feb Only ICD 10 is
80%
of processes and technology Standards 2012, DOH and nationally adopted
systems in health (HISS/HITS) officially WHO Reports
care delivery and issued
administration The Philippine Health
Information Network PHIN, KM,
(PHIN), ICT4H and PNIDMS and
various data management DOH Report ICT4H at national 5 Regional PHINs
systems and communities levels only, KM
of practice broadened/ team at CHD6
expanded
Percent of health workers
who are ICT literate and DOH Report 10% 40%
adept on HISS/HITS
Percent of municipal and
city health offices with
functional health service
DOH Report 40% 70%
statistics reporting and
disease surveillance
systems with trained HRH
A health data
Improved data quality warehouse
DOH portal An uploading
with increased data access established and used
uhmis2.doh.gov.ph system and QMS
and utilization with regular
reports

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 5 systems ( NCDs;
infectious disease;
disease surveillance ;
procurement,
Information and logistics and
application systems in financial
several priority areas DOH Report 1 management,
harmonized and document
implemented management;
hospital system with
Philhealth e-claims
modules and blood
supply
Data visualization system Dashboard with
DoH reports Phil. Health maps
established Health mapping
Knowledge Management
1 at national level,
hubs are expanded at DOH report 3 regional hubs
1 CHD
sub-national levels
% of hospitals with
PhilHealth Report 1% 100%
PhilHealth e-claims
% of hospitals with
functional management DOH- 45 DOH hospitals:
information system and DOH report LGUs – 36 90%
compliant with HISS/ LGU hospitals: 30%
HITS
National Telehealth
DOH reports and Several pilot NTSP program
Services Program (NTSP)
contracts projects institutionalized
established
The private sector Institutionalization of
data is system for gathering
50% of system in
incorporated into health information private
DOH Report 1% place and
the administrative sector for administrative
institutionalized
reporting system of reports
the government

STRATEGIES FOR 2011-2016

 Development and promotion of the eHealth agenda

 Development, promotion and adoption of critical health application systems , including real time
reporting and recording of health information
 Adoption of national data, ICT and relevant eHealth standards
 Enhancement and expansion of stakeholder collaboration for both health data producers and users
under the Philippine Health Information System and ICT for Health
 Creation of the National Telehealth Services Program
 Public-private partnership for eHealth and development and implementation of various systems

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6.3. INTERNAL MANAGEMENT SYSTEMS

6.3.1. Financial Management

Having strong financial management systems is of utmost importance, especially in the health sector. This
ensures that scarce resources are used optimally and that necessary controls are established. Inefficiency and
ineffectiveness adversely affect health outcomes by compromising the delivery of health goods and services,
especially to the country’s most vulnerable groups. Among the crucial processes involved in financial
management are financial planning, budget formulation, budget execution, accounting, financial reporting,
and internal control.

Even though promising systems are already in place, the following limitations continue to impede
effectiveness and efficiency in financial management:

1. Inconsistent implementation of financial processes, procedures, and guidelines at both national and
local levels;
2. Lack of integration of the financial management systems;
3. Lack of a budgeting system that follows medium-term budget planning and prevents resource gaps in
implementing multi-year priority health programs and activities;
4. Poor monitoring and evaluation of financial management;
5. Absence of an efficient information system that links DOH offices and LGUs;
6. Restricted government health budget; and
7. Difficulty in managing a highly decentralized system (NOH 2005, 138-9).

As a response to these limitations, the Public Finance Management Reform Strategy was launched in 2009
with goals of having improved budget credibility, improved budget execution, and improved internal controls
(F1, 1-7).

6.3.1.1. Improved Budget Credibility

A credible budget serves as an instrument that ensures that public resources are delivered reliably and
predictably. Efficiency will be promoted by integrating priority-setting, planning and resource allocation.
Under this objective, the following reform initiatives are highlighted:
1. Development of the Health Sector Expenditure Framework (HSEF), a Medium-Term Expenditure
Framework (MTEF) for the health sector, to better align budget with priority policies
2. Preparation of budgets using DOH Organizational Performance Indicator Framework (OPIF), in
coordination with the Department of Budget and Management (DBM). OPIF is intended to measure
the agency’s performance in the implementation of PPAs with emphasis on major final outputs;

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 3. Operationalization of the Program Planning and Budget Development Committee (PPBDC), which
improves budget preparation by reinforcing the links between planning and budget.

6.3.1.2. Improved Budget Execution

Improving budget execution entails making reliable information accessible to managers at all levels in the
DOH for enhanced monitoring and evaluation. This enables early detection of problems so that necessary
corrective measures may be taken before the situation gets out-of-hand. Steps taken to achieve this goal
include:
1. Installation of the Electronic New Government Accounting System (ENGAS), which links CHDs,
DOH hospitals, and the Central Office to form a DOH-wide financial information system. It
ensures the correctness, reliability, completeness and timeliness in recording government
transactions. The new system also generates financial reports, in accordance with generally
accepted accounting principles.
2. Integration of procurement, logistics, and financial management information systems
3. Development of an Executive Information System (EIS) and Finance Tracking Module through a
DOH Public Expenditure Tracking System (ETS), which is interfaced with the integrated
procurement, logistics, and financial management system that is used for the regular reporting of
actual expenditure against the budget listed by PPA.

6.3.1.3. Improved Internal Controls

Improving internal controls involves establishing and maintaining a network of systems to ensure effective
operations; economic and efficient use of resources; compliance with policies, procedures, laws, and
regulations; safeguarding of assets and interests from losses; and integral and reliable information. Significant
strides under this goal include the following reforms:
1. Operationalization of a Monitoring Unit within the Financial and Management Service
2. Use of scorecards and other monitoring tools to measure outputs and outcomes
3. Development of the Financial Management Services Operations Manual and Internal Audit
Manual
4. Upgrading the Internal Audit Division into the Internal Audit Service, a move to implement the
shift from the traditional to a risk-based and process-focused approach towards internal audit
5. Preparation of a DOH risk identification and control matrix as part of the Risk Management
Program
6. Operationalization of a Property Management Unit under the Administrative Service
7. Development of an Asset Management System in the Central Office, CHDs, and DOH hospitals
8. DOH-wide implementation of National Guidelines on Internal Control Systems (NGICS)

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 9. Use of e-banking facilities to improve the efficiency of operations, such as fund transfers and
ATM payroll systems
10. Setting up of the Anti-Graft Initiative as a system of control that aims to minimize corrupt
practices, enforce penalties and sanctions, and establish a system of accountability and transparency
for those who are entrusted with government resources.
Cutting across all these proposed reforms are the key concepts of collaboration, integration, and enhanced
monitoring and evaluation. It is of utmost importance that stakeholders work together during the planning
and appropriation phases – priorities must be identified and addressed, resources must be allocated
appropriately (i.e., prevent underestimation and overestimation). Moreover, systems must be utilized
optimally and integrated to ensure that financial information flows across agencies, thereby promoting
transparency, accountability, and enhanced decision-making. Integrated systems also pave the way for better
monitoring and evaluation.

6.3.2. Procurement Management

The DOH has invested in management and training systems to support the implementation of reforms
relating to procurement procedures and the delivery of health services. Additional checks and balances,
particularly in the form of monitoring and evaluation, are advisable to assess and document the impact of
these tools on the DOH’s capacity to manage and allocate health expenditures.
Challenges previously identified that hamper the efficient administration of limited health resources remain
largely exigent. Examples of these include: (1) Inconsistent implementation of procurement processes,
procedures, and guidelines at national and local levels despite the development of management tools and
training programs. (2) Inadequate coordination of activities between the various offices overseeing
procurement. (3) Delays in procurement processes due to lack of unified standards in terms of product
specifications as well as required documents on the end user side. (4) Limited consultation regarding desired
services and lack of participation among firms and individuals resulting in bid failures.

To address some of these challenges, the Philippine government is overseeing the following interventions:
(a) Implementation of Republic Act 9184, or the Government Procurement Reform Act. Through
institutionalized procurement planning functions and a procurement monitoring system in Centers for
Health Development and DOH hospitals, the law seeks to lower procurement costs, generate
substantial savings, and ensure that goods and services are available at service delivery points.
(b) Pilot testing of the Government Procurement Policy Board’s Agency Procurement Compliance
and Performance Indicators (GPPB-APCPI). The GPPB-APCPI is a system for monitoring
compliance in the implementation of revised IRRs in CHDs and DOH hospitals.
(c.) Procurement Operations and Management Information System (POMIS) became operational in
June 2010 with the main function of tracking documents and activities. POMIS serves as a system to

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 integrate and standardize the information flow between the centralized offices responsible for
procurement operations and management.

6.3.3. Logistics Management

In spite of the continuing development of the processes and procedures, many challenges continue to hamper
the efficient and effective administration of limited health resources. These include:
1) Inconsistent implementation of logistics processes, procedures and guidelines at national, regional
(CHDs) and local levels;
2) Lack of integration between financial, procurement and logistics management systems;
3) Inadequate skills on the management of logistics systems at the central, regional (CHDs) and local
levels and
4) Poor monitoring and evaluation of logistics management (Department of Health 2005).

In the past years, improvements in the logistics department had been made in terms of employees’ skills
training, space maximization, and development of guidelines. The next five (5) years will address the issues of
implementation process, integration between and among departments, infrastructures, and human resource
requirements.

Training health workers is essential to improve quality assurance encompassing proper storage practices and
good manufacturing practices. This is in line with the Republic Act No. 9184 – an act providing for the
modernization, standardization and regulation of procurement activities of the government.
Another problem encountered is the manual processes of doing inventory. The lag time between updating
and reporting is a major issue leading to discrepancies between stock card count and physical count.
Therefore to address this, computerization of logistics processes and inventory is well under way. Not only
will it provide transparency of the processes and information on deliveries, but it will also strengthen other
activities of the drug management cycle, such as forecasting and procurement; and serve as a medium to
enhance financial data recording.

Last but not least, monitoring and evaluation procedures are needed to determine baseline data. From this,
interventions can be assessed in terms of their outcomes – which projects to terminate and which ones to
develop further.

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 NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: Ensure the efficiency and effectiveness of financial, procurement and
logistics management systems to support health program implementation.

Strategic
Indicator Data Source Baseline Data 2016 Targets
Objective
% Budget utilization based DOH Financial
76 (2010) 100
on planned targets Report
Financial, Number of budget DOH Financial
20 (2010) 2
procurement and augmentation requests Report
logistics % Procurement request DOH Procurement
management processed out of the total Service Report 60 (2010) 95
performance are requests received
improved % Regions with no stocks DOH
To be
retained in the warehouse Administrative 100
determined
for more than 3 months Service Report
Number of days to release DOH Finance To be
To be determined
funding requests Service Report determined
Number of calendar days to DOH Procurement
Transaction time process goods procurement Service Report 80-120 (2010) 40-60
is reduced request
Number of days to issue the DOH
goods from receipt of Administrative 15 days (2010) 5 days
request Service Report

STRATEGIES FOR 2011-2016

 Improve budget credibility, budget execution and internal controls

 Develop and institutionalize a strong monitoring and evaluation to ensure the smooth interaction of
the management organization framework components namely, human resources, training, logistics,
and relevant systems and tools
 Multi-level audit of current financial management tools and systems to establish a baseline for the
development of comprehensive training workshops to build the capacity of health professionals on
both national and local levels to manage finances and logistics in support of health sector goals,
 Advance role of procurement as a partnership in order to improve integration and cooperation
between offices as well as increase support from suppliers and end users,
 Develop a standardized records keeping system to improve transparency of procurement and
warehouse storage systems, including inventory tracking tools and system to measure lead times and
potential for spoiled program commodities.
 Establish infrastructures for logistics management like air conditioners and handling units such as
pallet trucks, weighing scales, carts, pallets, among others in the region and provinces
 Conduct trainings for supply officers and health workers on good practices for the proper handling
and storage of medicines and supplies.
 Computerize logistics processes for more efficient information management and immediate roll out
to the LGUs

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