Health as an Instrument
Towards National Development
Youth Leaders for Health Conference
October 24-26, 2013

Antipolo Cit...
Session Goal
Trends in health to anchor your initiatives. 

-> serves as an entry point in developing an agenda

Health an...
Our Public Health Context
Devolution of the Philippine Healthcare System in 1991
Fragmentation of Health Services

Inequit...
how do we improve
health?
Government Policy & Spending

Systems Development

People Participation
Out-of-Pocket Spending

India
Philippines
Malaysia
World

Thailand

Source: World Bank
Public Health Expenditure

Source: World Bank
What are the current health
needs of the country?
unhealthy statistics
Philippines
2001 2008

Pneumonia
Incidence

2010

652,000

Cases

Expected
to be top
10 in the
world
...
unhealthy Statistics
Senior Statistics Survey
79 Barangays, 9,000 Seniors
Hypertension

DOH & DSWD
estimates

that senior ...
healthy Statistics
Philippines

MDG Goal
55 deaths/
100,000

Thailand

Malaysia

99 deaths

64 deaths

29 deaths

per 100,...
Top 3 PhilHealth Claims
1st Quarter of 2011

Pneumonia 79,631
Chronic Renal Failure 68,739
Single Normal Spontaneous
Deliv...
PhilHealth Utilization
In District 3, Quezon City, only 17
people used PhilHealth out of the
600 we enrolled.
Participatio...
Preview of Health Complexity
Disease & Health Burden of the Poor
High Income/
Urban Areas
Life expectancy at
birth
Infant ...
Health Complexity
Vaccinations#
With%no%vaccinations%
Percentage%of%children%who%received%vaccines%

47.9%

46.9%

42.7%

...
Health Complexity
Contraceptive%Use%%
Use%of%any%Contraceptive%method%

Not%currently%using%any%

81.5%

54.7%
45.3%

53.2...
Health Complexity
Antenatal Care Trends
Percentage of women whose last live birth was protected against
neonatal tetanus
P...
Health Complexity
Knowledge#of#AIDS#
Percentage%of%women%who%have%heard%of%AIDS%

84.1%

99.4%

96%

40.3%

No#education#
...
Supply & Demand
STRENGTHEN

HEALTH
LEADERSHIP AND
GOVERNANCE
QUALITY AND
RESPONSIVE HEALTH
SERVICES

•  Municipal Accounta...
What have I learned?
We need to position our initiatives to create a
generative understanding of the complex
health issues...
San Isidro Story
Learning BHW Development

Building Accountability from the
Ground-up
From: Political Appointees

“NOON, inuutos ko ang
pagsunod sa programang
galing sa itaas. Maraming
intriga at reklamo,
mag...
To: Program Advocates

“NGAYON, ang meeting lahat ay
nagmumungkahi at naka-focus na sa
programa. Ang mga issues related na...
San Isidro Story
Maternal & Infant Mortality
went to zero for a long time

Household income increased

Tax revenue increas...
San Isidro Story
When we strengthen frontline
leaders, we deepen health ownership
and improve our program output.

What ha...
KN Senior
Wellness Program

Leadership in health is
about empowerment.

!

Ang ibig sabihin nito, ay
ang pagbibigay ng hal...
Engaging the Barangay
Leaders and Seniors
KN Senior Wellness
80-90% coverage of seniors in
79 Barangays, about 9,000
seniors engaged

Regular checkups to 4,500
seni...
KN Senior Wellness
We need to set regular, repetitive
engagements to shift the existing
mental models. These are actionrefl...
Quezon City Story
Health Leaders for Mothers

a maternal health development initiative

The RH Dialogue
MMR was zero for 2...
Quezon City Story
Health Leaders for Mothers

a maternal health development initiative

We need to go beyond the
debate an...
What I do now.
Health Leadership &
Governance Program

Engaging DOH Regions, Mayors, & Governors
towards Primary Health De...
Health Leadership &
Governance Program

What have I learned?

We need to
strategically engage
government to create
deeper ...
Finding a new kind
of leadership
DOH Regional Director Dr. Abdullah
"Okang" Dumama Jr. Keynotes the
leadership workshop of...
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Young leaders for health talk oct 24

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This was my talk for the Kaya Natin-Ateneo School of Government Young Leaders for Health Conference. The participants are medical school students from all over the country. The goal of the 3 day conference is to encourage them to craft a public health initiative for their selected community for a competitive grant at the end of the 3rd day.

My session goal was to frame public health as an instrument in national development. But at the same time, I wanted them to see their initiatives as a sound public health development project.

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Young leaders for health talk oct 24

  1. 1. Health as an Instrument Towards National Development Youth Leaders for Health Conference October 24-26, 2013
 Antipolo City The Office of Senator TG Guingona
  2. 2. Session Goal Trends in health to anchor your initiatives. 
 -> serves as an entry point in developing an agenda Health and poverty are intimately connected.
 -> health a factor in poverty alleviation Health is a complex issue which require leadership and technical solutions.
 -> a perspective that enable us to develop strategies that work. Some things I have learned that work.
 -> pick up a few practices & strategies for your initiative You need to see your work of promoting health as part of National Development
  3. 3. Our Public Health Context Devolution of the Philippine Healthcare System in 1991 Fragmentation of Health Services Inequities in Health Outcomes Rich Urban Life expectancy >80 yrs. < 60 yrs. Maternal Mortality Ration <15 >150 Skilled Birth Attendant Health Responsibility in Devolved System Poor Rural 92.4% 25.1% Mayor Key in Improving the System
  4. 4. how do we improve health? Government Policy & Spending Systems Development People Participation
  5. 5. Out-of-Pocket Spending India Philippines Malaysia World Thailand Source: World Bank
  6. 6. Public Health Expenditure Source: World Bank
  7. 7. What are the current health needs of the country?
  8. 8. unhealthy statistics Philippines 2001 2008 Pneumonia Incidence 2010 652,000
 Cases Expected to be top 10 in the world 780,000 Cases 18% of under 5 years old deaths due to pneumonia Top 2 leading cause of death over 60 yrs. old
  9. 9. unhealthy Statistics Senior Statistics Survey 79 Barangays, 9,000 Seniors Hypertension DOH & DSWD estimates that senior population will be at 10% by 2030 Diabetic 25% 15% to 20% Hypertensive range suffer from 40% Type 1 & 2 Pre-hypertensive diabetes WHO & NSO estimates 6.1% of population will be diabetic by Senior health needs are inevitable 2030
  10. 10. healthy Statistics Philippines MDG Goal 55 deaths/ 100,000 Thailand Malaysia 99 deaths 64 deaths 29 deaths per 100,000 per 100,000 per 100,000 live births in live births in live births in 2010
 2010
 2010
 down from down from down from 170/100,000 54/100,000 in 53/100,000 in in 1990’s 1990’s 1990’s Singapore 3 deaths per 100,000 live births in 2010
 down from 6/100,000 in 1990’s live births *source: CIA world factbook
 unfpa.org 41.7% 18.5% 45.2% 50.0%
  11. 11. Top 3 PhilHealth Claims 1st Quarter of 2011 Pneumonia 79,631 Chronic Renal Failure 68,739 Single Normal Spontaneous Delivery 55,519 Philhealth reduces out-of-pocket expenses at the same time it can serve as an instrument for PARTICIPATION.
  12. 12. PhilHealth Utilization In District 3, Quezon City, only 17 people used PhilHealth out of the 600 we enrolled. Participation leads to learning which changes behavior and improves the demand for health. This is key in addressing the complexity. Philhealth reduces out-of-pocket expenses at the same time it can serve as an instrument for PARTICIPATION.
  13. 13. Preview of Health Complexity Disease & Health Burden of the Poor High Income/ Urban Areas Life expectancy at birth Infant Mortality Rate Maternal Mortality Ratio Dr. Jaime Galvez-Tan, Former DOH Secretary Low Income/ Rural Areas >80 <60 <10 >24 <15 >150
  14. 14. Health Complexity Vaccinations# With%no%vaccinations% Percentage%of%children%who%received%vaccines% 47.9% 46.9% 42.7% 34.6% 19.1% 14.4% 1.8% No#education# Elementary# High#School# 2008 NDHS* Report on Vaccinations of Children and their Mother’s Educational Attainment 2.3% College#
  15. 15. Health Complexity Contraceptive%Use%% Use%of%any%Contraceptive%method% Not%currently%using%any% 81.5% 54.7% 45.3% 53.2% 46.8% 53.1% 46.9% 18.5% No%education%% Elementary%% High%school%% College%% 2008 NDHS Report on Use of Contraception by Women of Reproduction Age and their Educational Status
  16. 16. Health Complexity Antenatal Care Trends Percentage of women whose last live birth was protected against neonatal tetanus Percentage of women with antenatal care from a health professional 79.5 74.5 94.1 97 High school College 68.9 34.2 80.4 44 No Education Elementary 2008 NDHS Preliminary Report on Maternal Care Indicators and their Relationship to Mothers’ Education
  17. 17. Health Complexity Knowledge#of#AIDS# Percentage%of%women%who%have%heard%of%AIDS% 84.1% 99.4% 96% 40.3% No#education# Elementary# High#School# College# 2008 NDHS Report on Knowledge of Women of Reproductive Age of AIDS and their Educational Status
  18. 18. Supply & Demand STRENGTHEN HEALTH LEADERSHIP AND GOVERNANCE QUALITY AND RESPONSIVE HEALTH SERVICES •  Municipal Accountability •  Barangay Accountability •  Coaching, Mentoring and Monitoring HEALTH EMPOWERMENT AND ENTITLEMENT EDUCATION Improved Health Indicators ENHANCE SUPPLY SIDE •  Human Resource •  Facilities •  Medicines •  Innovative Programs DEMAND SIDE INCREASE •  Health Seeking Behavior INCREASED UTILIZATION OF RELEVANT HEALTH PROGRAMS AND SERVICES Where is leadership in addressing this?
  19. 19. What have I learned? We need to position our initiatives to create a generative understanding of the complex health issues in order to increase participation and ownership. ! We need to create engagement opportunities that enable people to discover their roles in the health development agenda and enable them to see themselves fulfilled in accomplishing these roles. How have we done this? The Office of Senator TG Guingona Let me tell you some of my stories that engage people.
  20. 20. San Isidro Story Learning BHW Development Building Accountability from the Ground-up
  21. 21. From: Political Appointees “NOON, inuutos ko ang pagsunod sa programang galing sa itaas. Maraming intriga at reklamo, magulo ang talakayan at natatapos ang meeting ng walang saysay.” LUISA L. IMBAG President of BHW & KaLiPi BL Advocate
  22. 22. To: Program Advocates “NGAYON, ang meeting lahat ay nagmumungkahi at naka-focus na sa programa. Ang mga issues related na sa program. Masaya ang mga BHW kasi may solusyon na.” “Nakagagawa na kami ng plano para sa susunod na activities. Ipinaglalaban namin ang aming ginagawa. MAY BOSES NA KAMI” LUISA L. IMBAG President of BHW & KaLiPi BL Advocate
  23. 23. San Isidro Story Maternal & Infant Mortality went to zero for a long time Household income increased Tax revenue increased What happened?
  24. 24. San Isidro Story When we strengthen frontline leaders, we deepen health ownership and improve our program output. What have I learned?
  25. 25. KN Senior Wellness Program Leadership in health is about empowerment. ! Ang ibig sabihin nito, ay ang pagbibigay ng halaga sa tao sa pagtugon sa sariling kalusugan. Kalusugan ni lolo at lola
  26. 26. Engaging the Barangay Leaders and Seniors
  27. 27. KN Senior Wellness 80-90% coverage of seniors in 79 Barangays, about 9,000 seniors engaged Regular checkups to 4,500 seniors Lifestyle change in our seniors What happened?
  28. 28. KN Senior Wellness We need to set regular, repetitive engagements to shift the existing mental models. These are actionreflection venues that create transformative learning. These venues deepen ownership and enable personal accountability. What have I learned?
  29. 29. Quezon City Story Health Leaders for Mothers
 a maternal health development initiative The RH Dialogue MMR was zero for 2012 in District 3 In facility birthing and Pre-natal checkup went up What happened?
  30. 30. Quezon City Story Health Leaders for Mothers
 a maternal health development initiative We need to go beyond the debate and establish areas of deeper understanding. What have I learned?
  31. 31. What I do now. Health Leadership & Governance Program Engaging DOH Regions, Mayors, & Governors towards Primary Health Development Bridging Leadership driven Public Health Development to address inequities WHO 6 building blocks to improve Health Systems
  32. 32. Health Leadership & Governance Program What have I learned? We need to strategically engage government to create deeper change. Engaging DOH Regions, Mayors, & Governors towards Primary Health Development Bridging Leadership driven Public Health Development to address inequities WHO 6 building blocks to improve Health Systems
  33. 33. Finding a new kind of leadership DOH Regional Director Dr. Abdullah "Okang" Dumama Jr. Keynotes the leadership workshop of DOH Region 11.
 Region 11 DOH CHD Leadership Workshop 
 "We cannot just be maintainers. HLMP* for the poor means we exercise our different ways to lead to help the poor. Sometimes leaders tayo, sometimes followers but we need to create new arrangements to improve health." *HLMP - Health Leadership & Management for the Poor
 Health Leadership & Governance Program

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