Improving Operations for Comprehensive Public Health Actions

PLANNING AND STATISTICS UNIT

Center for Health Development IVB

planningandstatisticsIVB@gmail.com

Convening a PLANNING GROUP

Health Impact Assessment and Sectoral Consultations

Dreams for community What Success would look like How things ought to be

Stating the WHAT and WHY

Enhancing benchmarks and baseline markers

Identify STRATEGIES

Levels to be targeted Universality of approach Human Rights-based Approach Targets of change; agents of change; community sectors Targeted information and skills training Modifying barriers, exposures and opportunities Changing the consequences Enhancing support systems and services Modifying policies and broader systems

Working on BEHAVIORAL CHANGE Identifying ACTION PLANS

UTILIZING THE STRATEGIC PLAN

How does the Evaluation/HIA Fit to the Strategic Plan

Internal and External Benchmarks

Aquino Health Agenda Millennium Development Goals LGU and CHD Scorecards

Health Impact Assessment

Nature and extent of potential impacts How it will effect potentially affected communities Consultation with program implementers and recipients

Strategic Plan ROAD MAP Equity considerations Range and depth of approaches Utility and validity of health programs

CHD IV B

Key Informant Information and Hearing the End of the Value Chain

PLANNING AND STATISTICS UNIT

Center for Health Development IVB

planningandstatisticsIVB@gmail.com

Objectives
To identify behaviors, needs and opinion of various

stakeholders affected by CHD programs To determine appropriate levels of decision making needed for future programs and activities To characterize the need or set of needs addressed by the program and to provide an explicit logic model why program activities are believed to result in expected changes To clearly define and articulate implementation status in the fundamental principles that guide the focus and structures of public health interventions

METHODOLOGY
RECIPIENTS / Target Clients
APPLICATI ONS

INTEGR AL
RISKS
DRIVERS

Other Stakeholde rs

Program Implement ers

Applications
Infrastructure and Construction activity Support and Enabling Services Policy Contestability Delivery of government services to the public

Provision of grants and other funding arrangements

Infrastructure and Construction Activity

Varies from a wide range of organizational paradigms
Evolved from sub-contracting work and managing projects using public/private partnerships for funding and investing

more infrastructure projects such as roads as well as social infrastructure including schools and hospitals

Support and Enabling services

Clear commercial analogues and substitution of provisions

Cost efficiency gains core functions

Policy Contestability
Governments have increasingly sought policy advice and

external quarters input and public service Recourse to think-tanks, research institutes, consultancy companies, private sector lobbyists and community advocates

Delivery of Government Services to Public

A mix of service delivery methods evolved using direct

service provision as well as the funding of other bodies to provide services

Subsidies to ensure availability of services of a reasonable

standard and applying licensing and regulatory arrangements designed to influence market for particular services (demand) Creation of a new market for the delivery of services (employment)

Provision of grants and other funding arrangements

a combination of wide arrangements has emerged across

the spectrum of government activity involving payment to individuals, businesses, non-profit organizations, institutions and other community-based groups for a range of a range of policy outcomes

DRIVERS
Diverse and arise from institutional, economic and social history Are largely historical the private sector or the charity sector were

active in certain areas prior to government involvement Have emerged as government grew in which the market could deliver many services otherwise provided by governments such as ICT, defense and telecommunications Come from an experience of government-delivered services which suggests that the public service has not focused effectively on services that needed to be tailored to an individual requirement (advice and training) Were responses to perceived public service inflexibilities Contain elements of cost-saving or budget efficiencies, such as market testing government corporate services of funding imperatives

DRIVERS
Diverse and arise from institutional, economic and social history Increasing interest in and particular views about, competition and
micro-economic reform, stressing that public services would be provided more efficiently and effectively, with greater client satisfaction in a more market-oriented environment which provided greater flexibility for management decision-making Simply logistical, like using existing service providers to support government service delivery in regional areas where government may not be strongly represented Policy of social inclusion has increased emphasis on the role and benefits of a strong community sector and government strategies to support that role

Focusing on the Large Scope Needs through Root/Causal Assessment

PLANNING AND STATISTICS UNIT

Center for Health Development IVB

planningandstatisticsIVB@gmail.com

Respondents
RECIPIENTS / Target Clients

86 RESPONDENTS
through questionnaire

108 PROGRAM IMPLEMENTERS

Focus Group Discussions/Interviews

Other Stakeholde rs

Program Implement ers

21 Municipal Health Officers 24 Public Health Nurses 2 Public Health Managers 18 Staff from Provincial Health Office 18 Staff from Provincial Health Team Office 25 Staff from CHD IVB

23 STAKEHOLDERS
Interviews (i.e. email) 5 from National Government Agencies 18 from Non-government Organizations

217
RESPONDENT S 1128/1300 (88%)

Respondents
Regional 14% Palawan 16% Oriental Mindoro 29% Marinduque 7% Romblon 18%

Occidental Mindoro 16%

Varied Nature of Devolved Government

(Additional Drivers and Applications)

Size and Complexity at the simple end of the spectrum

are arrangements varying from a single provider in a oneto-one relationship to multiple providers Level of network operations and integrations some are characterized by vertical relationships between LGU and CHD How the relationship between agency and provider is governed can be via contract, grants or subsidies and related requirements such as service standards and other regulation with significant variation evident in the degree of control exercised by government through these mechanisms

Varied Nature of Devolved Government

(Additional Drivers and Applications)

Service Contract governments use contractual

arrangements as organizational tools (including mental health and welfare) Supply chain formed to deliver a complex product to government Ad hoc activation of a network in response to a specific situation, often an emergency Channel Partnership non-government organizations carry out transactions on behalf of government agencies Civic switchboards facilitation by government of connections between diverse organizations to complement each other in delivering a public outcome and producing new net value

Information

Empowerment

INTERN AL
Operations Financial

EXTERN AL

Internal/External Center for Health Development IVB (Agency)

PLANNING AND STATISTICS UNIT

Center for Health Development IVB

planningandstatisticsIVB@gmail.com

1. Program Evaluation
Not practiced consistently across program areas nor

sufficiently well-integrated into the day-to-day management of most programs Necessary for fulfilling CHDs operating principles for guiding public health activities

Using science as a basis for decision-making Expanding the quest for social equity through public health action Performing effectively as a service (technical) agency Making efforts outcome-oriented Being accountable

Underscore the need for programs to develop clear plans,

inclusive partnerships, and feedback systems that allow learning and ongoing improvement to occur

Recommendations
Evaluation should be tied to routine program operations

when the emphasis is on PRACTICAL, ONGOING evaluation that involve all levels of the value chain inclusion of evaluation in PES Assign values to program activities merit (quality), worth (cost-effectiveness) and significance (importance) at the beginning of a program and revisit it through implementation
In what context does the program exist? What aspects shall be considered in program performance? What standards shall be reached for the program to be

considered successful? What evidence will be used to indicate how the program has performed? How will the observations be used to improve public health

Recommendations
Performance management arrangements to support

delivery of outcomes with and through providers are ought to be built into the upfront design of approaches Performance reporting requirements are as streamlined as possible, focusing on data that is required for effective management and operation of any initiative and ensuring that timing, content and mechanisms are not counterproductive but user-friendly Performance measures and reporting systems are reviewed regularly and adjusted where required Skills development in performance management is a recognized area for project design and investment

2. Policy Guidelines Implementation

Interpretation of guidelines from different value chains

compromises the validity of operations (localization of national policies)

Transfer of guidelines from Regional office to DOH Reps are

not properly endorsed resulting to multiple voices in the periphery

Implementation of guidelines are not in full cycle programming, planning are okay but lacks monitoring magaling lang sa una, matapos ang ilang linggo wala na Policy Notes from Central Office are too rigid that are,

most of the times, not applicable to Regional Implementation

Recommendations
CHD should find value in KM as a tool

in systems analysis and in knowledge sharing

Interrelatedness Differentiated Context Independence Wisdom

FLO W

Knowled ge
Informati on Dat a Mundane Understanding Integrated

Recommendations
Policy briefs can be an option for simplifying the guidelines Leading a community dialogue - expand the base of

constituencies, reach common ground, sustain ongoing community discussion, building the capacity to act on ideas, focus organizational investment and inclusively monitor the initiatives Establish and institutionalize feedback mechanisms along communication lines

3. Capability Requirements
Skills, systems and organizational culture is not inline with

the implementation mode adopted

SKILLS should center on public service working as an

enabler or facilitator, rather than a doer; having the skills to deliver with and through others

Interpersonal communication has been a perennial challenge

SYSTEMS needs to be rehashed by an in-depth and

evidence-based understanding of how systems work, including trial and adjustment ORGANIZATIONAL CULTURE - supportive organizational systems must be in place

Administrative - We hit the ground running!

Recommendations
Organizational leadership that provides strong strategic

directions on building public service capability and demand-driven health services

SKILLS focus on skills in systems thinking, network

building and fostering relationship management that is developed, valued and supported through recruitment, development and increased mobility between and among sectors

Integration and connectedness is a design critical feature (integration approaches)

SYSTEMS develop core capabilities in a host of areas

where presently have scant experienceconceptualizing the network, integrating it and developing effective knowledge sharing practices across the network

Fit-for-Purpose Accountability, Performance Management , service stability and transition arrangements Providing for the capacity to capture learning from the network while supporting goal congruence within the network

Recommendations
Zonal/TEAM Approach to public health programs and

activities

Developing effective relationships between CHD and sectors in building social inclusion and ensuring of consistency of treatment across all Devising standards to guide accountability between CHD and the sector Recognizing the social and economic value of the sector, as well as its independence (welfare of health workers benefits and support) Providing a vehicle for consulting about, and addressing, social inclusion priorities Creating opportunities to hear the views of disadvantaged and marginalized residents of MIMAROPA Strengthening sector capacity to deliver efficient and effective services and promote innovative policy and

Recommendations
Organizational leadership that provides strong strategic

directions on building public service capability and demand-driven health services

ORGANIZATIONAL CULTURE forging connections in an

increasingly fluid environment of public sector delivery (interagency and inter-jurisdictional collaborations)

Complex network applications requiring significant investment of resources High-level management attention and stakeholder engagement

VOLUNTEER MANAGEMENT Third Sector Parties Barangay Health Workers, SK Federation, Community Organizers and Donors STAKEHOLDER CONGRESS

Government, Prime Contractor, Third Party as Integrators Develop baseline behavior patterns and find apt indicators to measure it

4. Generating Public Value

Prioritization of local health programs by LCEs are not

inline with Regional goals and directions due to public value loss
further worsened due to programs without financial

counterparts programs implemented is less flexible or not flexible at all to local peculiarities there is no joint accountability there is no avenue of how can services of quality be delivered, service continuity assured and access to public scrutiny and redress when things go wrong

Recommendations
A differentiated response to clients/citizens is needed;

flexibility and innovation are favored more than control;

Using PRECEDE/PROCEED participatory model Phase 1: Social Diagnosis Phase 2: Epidemiological Diagnosis Phase 3: Behavioral and Environmental Diagnosis Phase 4: Educational and Organizational Diagnosis Phase 5: Administrative and Policy Diagnosis Phase 6: Implementation Phase 7: Process Evaluation Phase 8: Impact Evaluation Phase 9: Outcome Evaluation

Recommendations
Fostering strategic conversations on the practical implications for

accountability, particularly in initiatives involving the devolution of decision-making power and based on community collaboration Fit for Purpose Accountability

Responsibilities and accountabilities of players are identified Cost-sharing (degree of specificity and flexibility attached to health services) Shared commitments and parameters and a strong sense of common goals Strong Local Governance arrangements and capability

Safeguarding citizen satisfaction and trust

Testing of citizen satisfaction and experience and the active use of

feedback as a basis for service improvement, forms part of systems design and ongoing implementation Trialling models of coordination and joined up government from the Citizen Point of View Fostering research and evaluation in order to know what works including into both people and places policies

Recommendations
Avenues for complaint and redress and information for service

users
Effective citizen complaint and redress are vital in building public

confidence Quality of feedback mechanisms drives continues improvement in health service delivery Openness and transparency through public dissemination of information on provider performance can play an important role in strengthening public trust

Putting Citizens at the Center of public health programs

Developing services based on bureaucratic needs

5. Policy/Delivery Splits
Implementation is inconsistent and not aligned with agency

objectives
Less mobility and interchange between sectors/division Less avenues for interaction with network members Minimal analysis on user experience information (client

surveys, analysis of complaints data)

Recommendations
Involve an inherent revisiting of the nature and extent of

the purchase/provider split

Create more initiatives where decision-making power is shared

6. Third Sector Capacity

Less involvement of critical agency partners

Establish documented partnerships among existing

engagements

Recommendations
Volunteer Management can lead work across government,

enable the sector to campaign for change, deliver public services, promote social enterprise and strengthen communities
Drive cross-government action to improve partnership

working and ensure better terms of engagement between the third sector and the government Invest in programs designed to develop and promote the sector Forge a policy and regulatory environment favorable to it Develop a strong evidence base and analysis function for third sector activities

Internal/External Center for Health Development IVB (Agency)

PLANNING AND STATISTICS UNIT

Center for Health Development IVB

planningandstatisticsIVB@gmail.com

1. Overly Onerous Reporting Requirements

Develops red tape and provider inefficiency

Unnecessary administrative burdens being imposed

on service providers, recipients and communities arising from duplication between organizations An overly rigid compliance paradigm with unthinking adoption and application of standard procedures and requirements stifling innovation and a collaborative approach

Recommendations
Require supportive organizational systems such as ICT

platforms to determine which systems can be systematized through networks

This can involve multi-tierred arrangements comprising information

on providers performance; procurement system; budget requests and financial plans; performance management; equipment utilization, systems support, e-modules for programs, etc.

Optimization of newly procured information technology

equipment and take advantage of the data center to be established in the region
CHD intranet where all office documents are stored, modified and

utilized

2. ICT Skills Shortage and Minimal Service Utilization

Lack of personnel to handle the many information

systems that DOH is implementing Lack of collaborative approaches to systems development

Recommendations
Develop a comprehensive database of monitoring systems

of programs, if not, an online COP (Community of Practice) website for all monitoring systems Continuous education on ICT technicalities possible partnerships with educational institutions (PPPs) Partnerships with Third Sector organizations (NGOs) in resources such as websites, making information readily available High-level strategic, project management and operational ICT skills is critical to providers with the move and establishing service standards

Internal/External Center for Health Development IVB (Agency)

PLANNING AND STATISTICS UNIT

Center for Health Development IVB

planningandstatisticsIVB@gmail.com

1. Health Workers Welfare

Dismay among health workers in the LGUs on the

inconsistent implementation of the Salary Standardization Law and magna carta benefits
ang dali lang ng implementation sa mga taga-region,

pero sa amin, pahirapan front liners kami pero pag naghablahan na, wala na

Recommendations
Enhance lobbying efforts through a TEAM

approach to Local Chief Executive discussing the Magna Carta Benefits and the need to implement the standards for SSL A portion of the Inter-agency meetings (including the local government unit) shall cover orientation/implementation on the Magna Carta Benefits

2. Indirect authority/relationship over MHOs and PHO

Resulted from public value loss of programs Ang bilis humingi ng reportswho cares, hindi naman namin kayo boss One of the dimensions of a devolved agency in terms

of implementation Ineffective feedback loops between program development and delivery

Recommendations
Fostering strategic conversations on the practical implications

for accountability, particularly in initiatives involving the devolution of decision-making power and based on community collaboration Fit for Purpose Accountability

Strong Local Governance arrangements and capability

Providing guidance on managing accountability in different

implementation approaches regarding lessons learnt and pitfalls to avoid Ensuring that program development is informed by on-theground intelligence and experience, including by means of mobility and interchange, avenues for interaction with network members, collection of provider and user views and evaluations

Internal/External Center for Health Development IVB (Agency)

PLANNING AND STATISTICS UNIT

Center for Health Development IVB

planningandstatisticsIVB@gmail.com

Misconstrued Finances
Delineation of financial responsibility over

programs
Monthly Request for Cash Flow Programs Obligation Requests

Complex contractual and other rules constraining

providers, limiting their ability to exercise judgment in working effectively with concerned beneficiaries Fiscal transparency over programs

Recommendations
Comprehensive public finance management that

is key/relevant for program implementers and health personnel Integration of internal control per division/section/unit can be helpful in monitoring finances

Logic Model
Public Capacity Enhanceme nt Communicati on
Partnership Research Developmen t

Surveillance

Change Physical Environments

Change Social Environments

PREVE NT AND CONTR OL PROBL EM

Leadership

Past experience show that health service is rarely a one-off task. It is best being understood not as a linear process leading from policy ideas through implementation to change on ground but rather as a circular process involving continuous learning, adaptation and improvement, with policy changing in response to implementations as well as vice versa.