2. Kalusugan Pangkalahatan
The Aquino Health Agenda
to achieve universal health care by:
• Providing adequate financial risk protection,
especially for the poor*
• Ensuring sustainable access
to quality health care facilities and services
• Attaining Millennium Development Goals
(MDG) for health through focused public health
efforts
*refers to poor households listed in the NHTS-PR
slide 2 of 27
4. Financial Risk
Protection
Access to
Quality Health
Facilities
Attainment
of MDGs for
Health
Modernization
of the
Philippine
Orthopedic
Center
Vaccine
Self-Sufficiency
Development
Objective
Agreement
between PHL
& USA on
Improved
Family Health
THE AQUINO
HEALTH AGENDA
slide 4 of 27
5. US-PHL Development
Objective Agreement
• Development agreement will help:
– Fulfill social contract with
the Filipino people
– Attain the MDGs on health
– Reduce inequities in health status
with a special focus on ARMM
and CCT recipients
slide 5 of 27
6. US-PHL Development
Objective Agreement
• MOI signed by Sec. Ona and DA
Steinberg last May 5, 2012
• Agreement can be signed or
announced in Washington on
June 7, 2012
• Total project cost: US$ 197.25 M
(PhP 8.1 B)
• US $157.8 M (PhP 6.5B) of USG
grant via USAID (2012-2017)
• US $39.5 M (PhP 1.6B)
counterpart by PHL from
DOH regular budget
slide 6 of 27
7. INDICATOR
BASELINE
2008 NDHS (%)
DOH 2016
TARGET (%)
USAID 2017
TARGET (%)
USG Assisted-Areas
Component 1: Family Planning (FP) and Maternal and Child Health (MCH)
Contraceptive prevalence rate
of modern methods
34 67 43
Unmet need for FP 20 10 14
Deliveries with skilled birth attendants 62 90 78
Facility-based deliveries 44 90 64
Pregnant women with at least 4 ANC 74 95 90
Infants exclusively breastfed (0-6 months) 34 70 63
Under 5-children with diarrhea
treated with ORT
59 100 70
Fully immunized children 80 95 90
Vitamin A supplementation 76 90 90
Component 2: Tuberculosis (TB)
Case detection rate 73 (2011) 85 85
Cure rate 82 (2011) 85 90
slide 7 of 27
8. N
Priority Areas
• FP/MCH*
– 40 provinces/cities
including 25 current sites with high
unmet need for FP/MCH
• TB*
– 26 provinces & 10 NCR cities
with low case detection and cure
rates
* Including all ARMM provinces
slide 8 of 27
9. Financial Risk
Protection
Access to
Quality Health
Facilities
Attainment
of MDGs for
Health
Modernization
of the
Philippine
Orthopedic
Center
Vaccine
Self-
Sufficiency
Project II
Development
Objective
Agreement
between PHL &
USA on
Improved
Family Health
THE AQUINO
HEALTH AGENDA
slide 9 of 27
10. Vaccine Self Sufficiency
Project II
• Construction of a current good
manufacturing practices (cGMP) vaccine
facility in the Research Institute for Tropical
Medicine through PPP (Build-operate-
transfer) for the production of combined
DPT, Hepatitis B and HIB vaccines;
Hepatitis B (single vaccine) and Tetanus
Toxoid
• DOH to procure from private partner for
Expanded Program for Immunization
vaccine requirements at 20% discount
slide 10 of 27
11. Objectives of VSSP II
Contribute to the reduction of under-5 mortality rate by:
• Ensuring adequate supply of the vaccines
• Reducing the cost of combined DPT, Hepatitis B and HIB vaccines;
Hepatitis B (single vaccine) and Tetanus Toxoid
• Ensuring acquisition of technologies in pooling and filling
of vaccines, establishment of facilities for filling, labeling and
packaging of vaccines as well as analytical laboratories
slide 11 of 27
12. Implementation Schedule
slide 12 of 27
Activity 2012 2013 2014 2015 2016-21
Tender Activities
Site Development / Permits
Engineering and Project Management
Production Building with Process Installation
Import (and Supply) of Naked Vials
Local Installation and Start-Up
GMP Certification and Validation
Start of Production
13. Cost and Financing
slide 13 of 27
Component
Foreign Component Local
Component
(PhP)
Total (PhP)
USD PhP
1. Basic Design Modules and Process 225,000 9,900,000 0 9,900,000
2. Manufacturing Building, GMP 6,364,555 280,040,420 112,016,168 392,056,588
a. Process Building, Installation & Transportation 2,205,555 97,044,420 38,817,760 135,862,188
b. Process Equipment & Piping (incl Installation) 4,064,000 178,816,000 71,526,400 250,342,400
c. Standby Power Supply 95,000 4,180,000 1,672,000 5,852,000
3. Engineering Manufacturing Bldg. &
Process
800,000 35,200,000 0 35,200,000
a. Proj. Mgt., Design Mgt. & Engineering 800,000 35,200,000 35,200,000
4. Commissioning and Qualification - Bldg. &
Process
130,000 5,720,000 0 5,720,000
5. Commissioning and Qualification
Manufacturing Bldg. & Process VSSPI
100,000 4,400,000 0 4,400,000
6. Govt. Right-of-Way 16,500,000 16,500,000
7. Site Preparation 3,000,000 3,000,000
8. FS & Environmental Study 7,500,000 7,500,000
Total Cost Estimate 7,619,555 335,260,420 139,016,168 474,276,588
(Exchange Rate: USD 1 = PhP 44)
14. Financial Viability &
Government Savings
Net present value PhP 1.08 B
Internal rate of return 24.56%
Total savings (2013-2021) PhP 6.06B
slide 14 of 27
16. Philippine
Orthopedic Center
• The proposed modernization of the Philippine Orthopedic
Center (POC) envisages its transfer into a new 700-bed
capacity facility to be located at East Avenue, Quezon City, to
be developed and operated by the private proponent along with
all required infrastructure.
• This will transform POC into the country’s leading
musculoskeletal & neurological medical services provider
comparable with global standards
slide 16 of 27
17. Implementation
Arrangement
• Build-Operate-Transfer
• Concessionaire to design, construct, finance,
equip, operate, maintain and transfer the
Hospital; responsible for all costs arising as a
result of its rights and obligations under the
Concession Agreement
• DOH to bear the cost of site and half the annual
cost of the Independent Consultant (IC)
• Voluntary transition of medical personnel to new
POC
slide 17 of 27
19. Need Gap Analysis for POC
Infrastructure Constraints Solutions facilitated by Modernized POC
534 beds utilized out of 700 sanctioned
beds, sub capacity operation at 70%-
75% levels
Private sector efficiency in operations ensures
capacity utilization at 90-95% levels
Staff to bed ratio presently at levels
lower than ideal ratio
Staffing mix at New POC facility to ensure the ideal
staff to bed ratio of 2.25 persons/bed
Only primary and secondary medical
services being provided at present
Super specialty tertiary care with modern equipment
and select medical staff
Lower than average period of discharge
for admitted patients
Private sector efficiency enables reduction in
discharge period from present 22 days to 6 days
Limitations in catering to non-citizen
patients or medical travelers
Medical tourism patients identified as part of overall
patient mix served at new facility
Present Status of POC slide 19 of 27
20. Plan for Modernized POC
Infrastructure Profile of New POC:
• Over 51,000 sq. mtrs const. area
• 2 blocks of 13 plus floors
• Interconnected at all floors
• 700 plus beds facility
• In house diagnostic facility
• Distinct functional services:
segregated areas for general &
specialized wards, (ICU, SICU, PICU,
etc.)
“SPECIALIZED NATIONAL ORTHEOPEDIC HEALTH CARE CENTRE”
Patient Profile:
• 70% of patients serviced
comprise of Sponsored
Category*
• Remaining 30% comprised of
Pay patients, Medical
travelers also targeted
Subsidy benefit utilized for servicing ‘needy’ sponsored category
patients, in line with Universal Health Care agenda
*Sponsored Category Patients include Phil Health Service Patients & Pure Service Patients
slide 20 of 30
21. Total project cost: P 5,691.50 million
Government Sector counterpart: 257.70 million
Private Sector counterpart: 5,433.80 million
Total Project Cost Breakdown
Project Cost Breakdown per Component
slide 21 of 27
Key Project Costs
22. Estimated Patients Benefitted
Projected
Cases 2013-15 2016 Operations Period 2038
In Patient Construction
Period
33,000 34,750 36,500 38,250 40,000 40,500 40,500
204,500 211,750 217,000 222,000 225,500 226,750 227,500Out Patient
Total Patients Served 237,500 246,750 253,500 260,250 265,500 267,000 268,000
Start of
Operations End of
Contract
• More than 237,000 patients served each year by the
modernized POC facility in IPD & OPD
• Nearly 268,000 patients projected to be benefitted annually by
the end of the BOT contract
slide 22 of 27
23. Benefits for Patients Served
• Positive perception for
Government Health care - use of
latest technology & proficient staff
• Reduced duration of patient
hospitalization & quicker discharge
- operational efficiency
• Personalized care & improved
patient satisfaction – better staff to
bed ratio
Direct patient benefits
• Reduction in morbidity cases
• Reduction in mortality cases
• Improvements in work force
participation rate
• Enhanced disability adjusted life
years**
Macro level benefits
**Disability Adjusted Life Years (DALY) – Estimated life years after factoring reduction in life on account of disability. One DALY can be thought of as one lost year of
"healthy" life
slide 23 of 27
24. Economic Benefit Head PhP Mn
Patient Satisfaction 25,536
Morbidity Related Health
Savings
7,174
Mortality Related Health
Savings
3,261
Medical Savings 22,943
Residual Value 2,224
Total Economic Benefit 61,138
Economic Viability Indicators
Economic Cost Head PhP Mn
Project Economic Cost 5,315
Economic O&M Costs 20,801
Equipment Renewal Eco.
Cost
5,191
Total Economic Cost 31,307
Return Parameter Indicator*
Economic IRR 39.01%
NPV of Economic benefits PhP 6,740 Mn
Based on Economic Cost Benefit Analysis slide 24 of 27
25. O&M Period
Hospital Operator/
Project Proponent
Project Management
& Monitoring Team
• undertakes O&M in
accordance with
MPSS and O&M
Manual
• DOH representatives: POC &
NCHFD
• monitors compliance with MPSS
and O&M Manual
Private
Proponent/SPC
DOH
• provides policy directions
• resolve disputes
Hospital Steering
Committee
Independent
Consultant
• Continues
providing
independent
third party
monitoring on
all operational
aspects
• Collectively constituted
with representation from
Pvt. & Govt.
slide 25 of 27
26. Summary
1. NEDA Board approval to sign the Development Objective
Agreement for Improved Family Health between PHL-USA
2. NEDA Board approval to enter into PPP agreement for VSSP II
3. NEDA Board approval to enter into PPP agreement for the
POC Modernization
slide 26 of 27
Kalusugan Pangkalahatan or KP is the Aquino administration’s health agenda to ensure that all Filipinos, beginning with the poor, are 1) Able to access a reasonable level of health services at minimal cost, by being enrolled in the National Health Insurance Program; 2) Cared for in modern health care facilities; and 3) Prevented from falling ill by using public health services to improve health outcomes and attain health-related Millennium Development Goals (MDGs).
KP will be accomplished by providing adequate financial risk protection through the expansion of PhilHealth coverage; upgrading of government hospitals and clinics; and refocusing of public health efforts and preventive care to the target beneficiaries.
At present, the Department of Health has three initiatives lined up for the approval of the NEDA Board. These initiatives are aligned with two of the three KP strategic thrusts.
In order to fast-track the attainment of millennium development goals for health, the DOH proposes 1) Vaccine Self-Sufficiency; and 2) a Development Objective Agreement between the Philippines and the United States of America on Improved Family Health.
The Development Objective Agreement between the Philippines and the United States of America on Improved Family Health includes an assistance package that shall be implemented by the United States Agency for International Development or USAID. It is aligned with the KP strategic thrust for the attainment of MDGs for Health, through the focused delivery of public/preventive care services to the poor.
The proposed Development Agreement will directly help in fulfilling the President’s social contract with the Filipino people, as it recognizes the importance of advancing and protecting public health, which in turn will increase social protection and engage communities in their own development.
Because the Development Agreement is closely aligned with the Aquino Health Agenda, it will also harness the strength of effective coordination of national government programs for poverty reduction at the local level, because it converges health interventions with the DSWD’s social welfare programs that includes the CCT/4Ps.
The Development Agreement with the United States of America is therefore expected to help reduce inequities in health status, with a special focus on the ARMM, and areas with CCT/4Ps recipients.
Last May 5, a Memorandum of Intent (MOI) signifying was signed by the Secretary of Health on behalf of the Philippine Government, and by USAID Deputy Administrator Donald Steinberg on behalf of the US Government. This is a prelude to the possible announcement or even signing of the Development Agreement proper, which can take place as part of His Excellency the President’s State Visit to the USA on June 7, 2012.
With a Philippine counterpart of only US$ 39.5 M (PhP 1.6 B), the Development Agreement represents US$ 157.8 M (PhP 6.5 B) worth of a US Government grant to be implemented locally by USAID over five years, from 2012 to 2017. It will be channeled to a health assistance program closely aligned with the Aquino Health Agenda to achieve Universal Health Care, specifically in the areas of family planning (FP), maternal and child health (MCH) services, and tuberculosis (TB), among others.
The following are the indicators to be monitored and evaluated to assess the implementation of the Development Agreement. The 2008 National Demographic and Health Survey (NDHS) will be used as the baseline, upon which USAID has determined targets for 2017 in its chosen areas of assistance alone, in due consideration of the DOH national targets for 2016:
An increase in the contraceptive prevalence rate of modern methods;
A decrease in the unmet need for family planning;
An increase in deliveries/births with skilled attendants;
An increase in facility-based deliveries;
An increase in the number of pregnant women who avail of four antenatal care services;
An increase in the number of infants who have been exclusively breastfed;
An increase in the treatment using oral rehydration therapy of children under 5 years old with diarrhea;
An increase in the number of fully immunized children;
An increase in Vitamin A supplementation; and
An increase in the case detection and cure rates of Tuberculosis.
The Development Agreement will provide health program assistance to forty (40) provinces and cities, which include twenty five (25) sites that have high unmet needs for family planning and maternal/child health services. The prioritization follows the concentration of the DSWD’s NHTS poor and CCT/4Ps families, and the NAPC’s priority 609 municipalities for poverty reduction.
For the eradication of tuberculosis, twenty six (26) provinces and ten (10) NCR cities will be provided assistance on account of their low rates of case detection and cure of TB.
All provinces of ARMM are included in the areas of assistance of the Development Agreement.
The VSSP II involves the construction of a current good manufacturing practices (cGMP) vaccine production facility which aims to:
1. Reduce the cost of combined Diphtheria, Pertussis, Tetanus, Hepatitis B and Haemophylus influenzae b vaccines (collectively referred to as Pentavalent V+), Hepatitis B (single vaccine) and Tetanus Toxoid;
2. Ensure adequate supply of the vaccines (vaccine security); and
3. Ensure acquisition of technologies in pooling and filling of vaccines which is a major component of the VSSP. Establishment of facilities for filling, labeling and packaging of vaccines as well as analytical laboratories.
The recommended concession period is at ten (10) years. Under the BOT modality, the private partner will be engaged, at its own expense, to cause the design and construction of the necessary structures, and supply, assemble, install, test, validate, including commissioning of all necessary machinery and equipment that are cGMP compliant related to the vaccine production facility.
The private partner shall commercially operate and maintain the facility at its own cost, including the supply of materials necessary for the production of the vaccine throughout the concession period.
On the other hand, the obligation of the DOH shall be that of annually procuring from the private partner the EPI vaccine requirement at 20% discount based on UNICEF prices until the end of the concession period.
RITM is adapting three approaches to accelerate progress in local vaccine production, attain sustainable supply of vaccines and cut the overall cost of procurement of EPI vaccines
The project is financially viable using the estimated weighted average cost of capital (WACC) of 10.26%, yielding a positive net present value (NPV) of PhP 1.11 billion and internal rate of return (IRR) of 25.20%.
These are the proposed sites for the program.
This is for the FP/MCH , Luzon,Visayas and Mindanao.
For the TB Project, here are the proposed sites for NCR, Luzon, Visayas and Mindanao.
