Benguet Province Host Inception Workshop

Session on Sharing of good practices with ABRA Delegates

Delegates saying Thank You with a song

Delegates Orientation at the Provincial Health Office

ABRA Delegates at the top of the mountains (Km. 52, Atok - Highest Point, Philippine Highway System)

One of the recognized achievements of concerted efforts of the different stakeholders in the province of Benguet is its organized and functional four (4) ILHZs. These gains from the Project, Strengthening the Local Health System of the Province of Benguet were shared to the Municipal Legislators and Health Workers of the Ladalada, VIP,Dolasan ILHZ’ of the Province of Abra on February 23 to 26, 2010.

This activity was sponsored by the DOH-CAR and through the concerted efforts of the LCE’s of Benguet, Abra , PHO, 4 ILHZ’s of Benguet and JICA.

Abra delegation personally observed and interacted through peer to peer learning from the experiences of established functional ILHZs. They noticeably observed the strong political support as evidence by the knowledge of the Governor on the different health and ILHZ activities, and the overwhelming presence of legislative bodies of Atok and Buguias Municipalities during the visit of these municipalities.

The Benguet Province showcased two ILHZs, the BLIISTT and Mt. Trail ILHZ with three Municipal Health Units. Tublay RHU for the BLIISTT ILHZ, Mankayan and Buguias RHU’s for the Mt. Trail ILHZ. These Municipal Health Units are a 3-in-1 Philhealth accredited facilities on Outpatient Benefit Package (OPB), Tuberculosis Directly Observed Treatment Short Course Chemotherapy (TB-DOTS) and Maternal Care Package (MCP). At Makayan RHU the delegation observed an excellent records management and the drug management caught their attention. The core referral hospitals Atok District Hospital, and the Benguet General Hospital, the BLIISTT ILHZ office and Mt. Trail ILHZ office at Abatan Emergency Hospital were likewise visited by the delegation.

To attain the objective of the Inception Workshop, which is to observe and learn from the ILHZ’s of the Province of Benguet and to replicate these good practices in their province, more interactive sharing was done on the last two days.

Overview of the DOH Replication was presented and so as other good practices by the four ILHZ’s was presented.

1. History of the establishment of the 4 ILHZs of the province by the PHO.
2. Common Health Trust Fund Mechanism and fund utilization by the Mt. Trail ILHZ. The Kapangan KMCH Kibungan (3K ILHZ) presented the gains from the Health Summit. This is an advocacy scheme by the ILHZ to empower the different stakeholders in the ILHZ on the health system.
3. Presentation of highlights of the referral system, on the localization based on the prevailing situation in each ILHZ.
4. Provincial Monitoring Tool for Health Programs and to monitor functionality of ILHZ. This strengthens the PHO monitoring skills.
5. LGU Drug Revolving Fund a project from the 1M assistance from the CHD for Inter-LGU Cooperation.

Majority of the inquiries were more on the CHTF mechanism. The legal basis, its sustainability, utilization of funds and how to prioritized activities to be funded by the CHTF.

A simple action planning workshop was done and presented with the highlights of learning’s from the delegation. The Abra delegation expressed with gratefulness their learning’s and admirations for the achievements of the Benguet Province ILHZ’s.

Dr. Norma C. Pacalso on her parting message encouraged the delegation, that what the province of Abra is experiencing now on the establishment of its functional ILHZ has been experienced by the Benguet Province before, with a saying “Beyond the clouds is a Silver Lining. ”

The interaction has been an enriching time for both Benguet and Abra Province. Apparently, the inception workshop was one big tremendous success. It proves that with team work and cooperation on any endeavour beats all the odds. Maybe, one unexpected benefit from working on the project all these years is a wholehearted feeling of cooperation and oneness. — Lilian Marie Laruan, MD, Mercedes S. Calpito, MD and Florence Tabur, DMD

Training on Local Health System in Japan

A certificate of completion was awarded after the final evaluation at Tokyo International Center

After the project accomplishment presentation

After the orientation on Japanese Society and Culture

The training aimed to understand the regional health system of Kochi prefecture, a sister prefecture of the province of Benguet, and to learn from their past experiences and developments so that good practices that can be replicated be applied in the province. More specifically, strengthening of the referral system and rational health facility planning are the main focus of the study. This study is part of the project: Strengthening of the Health System in the province of Benguet in cooperation with JICA.

The trainees were the chief of hospitals of the 5 district hospitals in Benguet and the Provincial Health Officer l namely : Dra. Nora Ruiz, Dra. Mary Joy Torio, Dr. Eduardo Calpito, Dr. Joseph Giovanni Frias, Dr. Satur Valentin and Dra. Norma Pacalso. The training lasted for 15 days, from January 26 to February 9, 2010.

We were accommodated at the JICA Tokyo International Center during the first week of the training. The first week of the training was spent by having a general orientation on the training program and on the Japanese society and people while we were waiting for our chest X-ray results. (They have to make sure that we were healthy.) It is noteworthy to know that it is the Japanese custom of using the family name in calling others and the degree of bowing has several meaning, from a “good day” nod at an angle of 5 degrees or a bow at an angle of 45 degrees to show deep respect when expressing gratitude or an apology. It was fun and amazing knowing and practicing some of the Japanese gestures and rules of etiquette during our stay. We paid a courtesy call to the JICA headquarters where we presented the accomplishment of the project for the past four years, comparing it from baseline at the beginning of the project.

We were warmly met by Mr. YOSHIMASA TAKEMURA, the Program Officer, Human Development Division and other staff who were impressed by the achievements of the project. We also presented the situational analysis of the health facilities of Benguet and the draft of health facility rationalization plan.

We moved from Tokyo to Kochi on the following week enjoying the sights of Japan as we travelled through experiencing the use of different modes of transportation, from the taxi, bus, train and plane. At Kochi it was a busy hectic but fruitful schedule learning the regional health system from health policy, facility development and planning, financing, roles and responsibilities of the different stakeholders on referral system and health facility development. These were done through lectures, question and answers despite their difficulties in communicating with us in English. We are very grateful for the presence of our coordinators who painstakingly interpreted for us. We were also given the chance to see their facilities at all levels of care for which we were so much amazed by the presence of such complicated complete equipments and technology to deliver the services at various levels of health care. We were just asking ourselves when will we be able to acquire even just afew of these?

The Health and Welfare department in Japan is one organization not like here in the Philippines where this departments are separate from each other. Their set-up provides a closer coordination for the provision of services both health and welfare.

They had merge some facilities which were encountering difficulties in the provision of services due to the lack of resources and built a more sophisticated, higher level hospital to be able to provide a more comprehensive health care to their people. Scholarships are offered to local residents to entice them to stay in the locality to practice their profession . All these were possible due to their existing policies on cooperation and planning and implementation.

Quality services are provided at all levels of care with the presence of the necessary logistics and resources. It was observed that medical care are provided only at hospitals and clinics while the preventive care like immunizations are provided by the public health (RHU’s). The back referral is properly planned and coordinated with the members of the family and the public health or welfare especially for the elderly who needs long term care Health promotion especially on the prevention of lifestyle diseases is very evident, through the collaboration and partnership of both hospitals and RHU’s.

On the health care insurance, it is either a Health Insurance for general employees, National Health Insurance for farmers and retirees or the long life medical care system (75 yrs+).

It was noted that even retirees have to pay for their insurance. As to the medical care benefits there is a cost sharing scheme of 70%-30 %co-payment, the 30% to be shouldered by the patient but still there is a cap limit to this. One important observation was that the medical care benefits are the same at all levels of care not unlike here in the Philippines where the medical care benefit is lower if you are at a lower level health facility. Also, there is a standardized fees for health services.

The emergency medical services evolved from the revision of the fire service law, the reason for which it is under the fire department. It provides that emergency patients not only those involved in accidents are taken cared of.

Our goal in this training program was to become capable of pursuing referral system strengthening and rational health facility planning. It was very evident that cooperation and coordination among stakeholders was very important in the achievement of all these.

Kochi prefecture expects to have a fall in its population with an increase in its elderly (over 75 yrs. old) population. The leading causes of mortality are malignant neoplasm, heart disease and cerebrovascular diseases which are truly the health problems of the elderly. This is coupled by the lack of doctors in the rural areas. The Emergency Medical Services is under the fire department, mange by fully trained first aider and personnel’s. Through the cooperation of Municipalities, they establish more sophisticated facilities which are subsequently funded by these cooperating municipalities.

These EMS had an average response of 5 minutes. Indeed, the presence of policies and implementation, the cooperation and coordination of partners are vital in the improvement/strengthening of services.

Interlocal Health Zones…….

Sustaining functionality and strengthening operations of the InterLocal Health Zones is a great task by the member Local Government Units which are necessary to attain local and national health goals with maximum use of resources in the zone in the provision of equitable & accessible health services to the constituents. These are achieved through a coordinative and unified planning, cooperative implementation of plan, sharing of resources and commitment to the objectives and goals of the ILHZ.

There may be a change in the Executive Committee (Execom) in view of the incoming national and local elections which will definitely affect the operations of the ILHZ, but is hoped that it would be a positive one, as former Health Secretary Duque said and I quote: “let us hope that what we have started continues, that the next administration will see the wisdom of the health reform agenda. We have already done our part, set the direction and laid the plan. It’s now for the next administration to sustain the course and proceed as planned”.

The Technical Management Committee (TMC) should look forward to any change of leadership in the Execom and must strive to propel the ILHZ towards the attainment of goals and objectives through conduct of regular meetings to discuss and implement planned activities, monitor and evaluate results which would be translated as health development of communities in the zone that would hopefully radiate to the neighboring ILHZs in the province.

All these will be done successfully if the ILHZ will be guided by the following principles as stated in the article on Network for good health of HEALTHbeat magazine November 2009 issue: the desired practice of inter-LGU coordination in health that is consistent with Local Government Code of 1991 as well as with the directions of health reforms is characterized by the following principles:

1. Voluntary action for mutual benefits.
2. Flexible forms of organization that is non-exclusive.
3. Results-oriented.
4. Sustained and evolutionary.
5. Purposive and developmental.
6. Universal and non-partisan.

These past 4 to 7 years of organization we have accomplished some of our expectations but due to responsibilities in our LGUs and some constraints we were not able to give a hundred percent of our time/effort to the Zonal activities… I admit it takes a lot of effort and commitment on our part to participate, for if others can, why can’t we? We certainly hope a continuous We certainly hope a continuous support from our leaders..our ILHZ manager who plays a great plays a great role in unifying the members and the approving body the Execom.

It will be a great challenge too to our incoming leaders in the Execom to embrace these health reforms and take a big stand to pull the ropes for the survival of these ILHZs in order to bring more health benefits to their constituents in the arena of bayanihan or Pagkakaisa sa Kalusugan!

So friends… let us still put our hands together and just like athletes we cheer….one.. two.. three.. Hurrah.. to: BLIISTT , New Mountain Trail, BKD and Triple K ILHZs!!!! — Judith Codamon, MD

A Travel to Remember

The training on local health system in Japan which was originally scheduled last October 2009 but was postponed due to typhoon Pepeng which struck the province had finally kicked off last January 26- February 2010. This was attended by the Provincial Health officer I and the 5 Chiefs of district hospitals .

The training aims to understand the regional health system of Kochi prefecture and be able to learn from their past experiences and development so that their good practices which are applicable to the province will be adopted. The study was focused on the strengthening of the referral system and rational health facility planning. The study tour started upon our arrival at Tokyo International Center wherein the first 5 days were devoted for orientation regarding the culture of Japan including our visit to a Japanese home ( Thanks to the family of Makoto Tobe ), medical examination ( chest X ray ), presentation of the training design by the JICA expert, and presentation of the progress of the project at the JICA headquarters in Tokyo.

After which, the team flew to Kochi and a visit to one of the medical region ( a counterpart of our ILHZ ) was started. The Hata public health and medical care region which was chosen as the study ground is considered to be the farthest of the 4 medical region. Because of its distance the Hata Kenmin hospital was built to provide an almost full range of comprehensive medical care.

The highlights of the study are series of lectures, demonstrations and guided tours to their health facilities and equipments from the nursing home to their level 1 and level 2 hospitals up to the level 3 referral and training hospitals including Hata Chuo fire department which interestingly handles the ambulance system. The showcased health facilities and equipments are world class and state of the art and they did not fail to attract our appreciative eyes.

On our way back to Tokyo, we passed by and get the chance of a lifetime to visit 2 more important cities of Japan, the modern city of Okayama and the ancient city of Kyoto. The sightseeing in these two cities is filled with fun and excitement and what makes it more delightful is the experience of walking through the flakes of falling snow while passing underneath the shelter of the cherry blossom tree. It may appear that the journey was very long and tiring however, it was not, thanks for the services of Shinkansen ( bullet train ), the element of comfort was never sacrificed, it made our travel light and easy.

The final evaluation was done in Tokyo wherein the learning were presented including the action plan that we will try to implement upon our return to the province. Japan is really blessed with diverse natural beauty and unique culture, and together with a hospitable and respectful people, every Kenshuin ( trainee ) will always say; Mata kitai desu ( I’d like to come again ). — Satur Valentin, MD