General Description of the aop health Situation as of end of 2008
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| Part of ensuring quality control and assurance is the accreditation of all main RHUs by the PHIC. For 2009, the PHO with technical assistance from the CHD 3 and PHIC shall conduct facility assessment of local public health facilities and make necessary recommendations to the MHOs/CHOs and LCEs to complete compliance requirements for accreditation.
Private-Public Mixed DOTS [PPMD] will be expanded to all municipalities and cities from the current three [3] existing PPMDs. Corollary training on the standard TB-DOTS will be provided to private physicians. Problems emanating from hospital-based TB program will be attended to to ensure standardization of treatment protocol from among physicians in private and public facilities. Local TB Diagnostic Committees and CUP will be re-organized and activated in all LGUs to strengthen area-level TB control and management. 2.2.2 HIV/AIDS/STD/STI Control Service The PHO in consultation with concerned LGUs and RHUs shall conduct assessment of high-risk areas and map out potential outbreak areas for sex-based infections. CSWs in the areas will be encouraged to come forward so that they may avail of free health services related to their lifestyle. Establishing social hygiene clinics in the high-risk areas shall be prioritized with funds coming from pooled LGU resources with support from the PGB and CHD 3. Training on Syndromic Management will be provided to health workers, including the development of IEC materials for target clientele. Trainers from the PHO and CHD 3 shall mentor concerned health workers on counseling of clients afflicted with HIV/AIDS/STD/STI. Local health boards shall be convened to draft resolutions on the control and management of HIV/AIDS/STD/STI for approval by the local legislative bodies. Inclusive of these ordinances are provisions for the procurement of medicines, drugs, reagents and other materials needed for the program. Local HIV/AIDS/STD/STI shall also be established in high-risk areas to take the lead in the planning, monitoring and evaluation of the HIV/AIDS/STD/STI Control Service program. 2.2.3 Dengue Control Service Vector control shall be implemented in all municipalities and cities as the primary strategy in dengue prevention and control. To reduce/eliminate dengue morbidity among children, dengue Skul Watch Teams shall be organized from among elementary and secondary schools. In coordination with the DepEd and principals, these teams shall ensure that classrooms are free of mosquitoes, especially at 4.00-5.00 in the afternoon where the Aedes mosquito strikes. Awards and citations will be given to schools declared dengue-free to generate student’s participation. Furthermore, these teams shall fan out to the communities surrounding the schools, searching and destroying known and suspected mosquito-breeding sites. House to house sanitation drives will also conducted by the general population through the leadership of the barangay councils. The PHO and LGU shall assist these efforts with the provision of vector control [larvicides, insecticides and other chemicals for defogging]. Health promotion activities will also be conducted to widen the reach of information. Health workers will be provided training on Vector Control and Entomology. 2.2.4 Emerging and Re-Emerging Infection Prevention and Control Service The PGB shall lay the grounds for the safety of its constituents from avian and swine flu and Ebola Reston viruses that have gripped the province in recent past. It shall enhance and finalize the Bulacan Manual of Operations for Avian Influenza, Swine Flu and Ebola Reston viruses. At the local level, the Barangay Health Emergency Response Teams [BHERTs] and Community-Based Emergency Workers [CBEWs] shall be organized and trained on various emergency situations and corresponding responses. The PHO and RHUs shall coordinate with the Department of Interior and Local Government [DILG] for the mobilization of barangay officials for infection prevention and control. Mechanisms will be established and/or enhanced to strengthen disease surveillance at the community [M/CESU] and provincial levels [PESU]. Updates on emerging and re-emerging infections will be continuously provided to all health workers at the RHUs, BHSs and district hospitals. Discussions on enhancing existing referral systems will be also be tackled during these activities. A separate training on communications planning for health workers and health volunteers will be given to equip participants on the various methods and approaches of informing the public on the dangers brought by emerging and re-emerging infections. Messages in different IEC forms developed from this workshop shall be disseminated to the general population in various health promotions and education activities. Through legislation and procurement, LGUs shall ensure that health facilities have adequate supply of emergency medicines, drugs, supplies and other commodities in the event of any infection brought by avian and swine flu and Ebola Reston viruses. 2.3. Child Health Improving the core competencies of health workers in saving children’s lives and ensuring their health will be pursued by the PGB and the LGUs. Various education and training forms and methods will be utilized to enable doctors, nurses, midwives, and health volunteers to contribute to the reduction of child mortality and morbidity in the province. These capacity building activities are: Basic Expanded Program on Immunization with IPC, Training on Integrated Management of Childhood Diseases [IMCI], Infant and Young Child Feeding [IYCF] Orientation on Reach Every Barangay Strategy, Orientation on CBMIS and FHSIS Reporting and Monitoring Forms, Women’s Training on Breastfeeding Counseling among others. The REB strategy, combined with the proper establishment of CBMIS at the ground shall determine actual number of children and unmet EPI needs. LGUs, through the PHO, shall ensure the adequate supply and timely distribution of immunization vaccines for children from the DOH CHD 3 under its regular Garantisadong Pambata program. Micronutrients and Oresol sachets for sick children will also be ensured. ECCD cards shall also be adequately secured. Vaccine refrigerators shall be purchased and deployed at the RHU to ensure availability of commodities. LGUs shall ensure the availability of immunization paraphernalia, i.e., syringes, needles, cotton among others. LCEs, with and through the approval of the legislative councils, shall ensure the procurement of adequate supply of reformatted Oresol, zinc and cotrimaxole for sick children. Other commodities to ensure child health, such as de-worming medicines, Vitamin A capsules for two [2] rounds, dental care products, The private health sector, particularly pediatricians and general practitioners, shall be mobilized and oriented on the DOH standard protocols for immunization. Through the guidance of the PHO and the CHD 3, a partnership shall be establish with the private health sector to ensure that all children, irrespective of social and economic background but particularly the poor, are given standard immunization shots and treated with established protocols. The existing Private Health Desk under the office of the PHO, shall form a mechanism to ensure reporting compliance of private practitioners in immunization and treatment of sick children to be integrated into the public health information system. Particular attention shall be given to the use of iodized salt in households and food and catering establishments. IEC materials will be distributed and posted in strategic locations to inform the general population on the benefits of using iodized salt. Local legislators shall be encouraged to pass resolutions supporting the Asin Law. RHUs with the assistance of law enforcement agencies shall regularly conduct inspections of market stalls selling salt and ensure compliance. Health promotions activities, in various forms and contents, will be aggressively pursued by the PHO and RHUs in an effort to reach mothers, parents and guardians in ensuring coverage of all children to undergo immunization. Mothers who have mentoring and good interpersonal communication skills shall be organized and further trained on breastfeeding counseling to guide young mothers on the practice of breastfeeding up to the first six [6] months after delivery. BHWs and Women’s Health Teams will educate and encourage young mothers to avail of the newborn screening procedure in the provincial and district hospitals. Another project worth continuing is the Mother-Baby Friendly Barangay where the different barangays vie for awards and citations for being a mother-baby friendly barangay. Dental care will also be pursued from among children of school age. LGUs with onboard dentists will be encouraged to formulate a comprehensive dental health plan for approval of the LCE and budget allocation from the legislative council. LGUs without dentists will be encouraged to hire one to take the lead in ensuring dental health care from among its constituencies. Preventive [oral examinations and prophylaxis] and curative [tooth extraction] dental care commodities will be secured to fully implement the dental health program. Ensuring universal coverage of children and sick children is the regular and accurate filling up of accomplishment reports and monitoring forms. Analysis of data from these progress reports and the CBMIS will determine gaps and deficiencies that health care workers can readily respond to. Transient families will also be monitored through a mechanism where LGUs can track them within and outside their borders to be monitored by receiving LGUs. While child health interventions are being implemented at the ground level, health workers and volunteers are to aggressively encourage members of the informal sector to enroll in the PHIC Sponsorship Program. As a vulnerable sector, the informal sector will derive social health benefits under the PHIC. 2.4. Maternal Health Mapping and comprehensive assessment of all public health facilities will be prioritized to determine where the Basic Emergency Obstetrics and New Born Care [BEmONC] facilities will be established. Once sites have been shortlisted and final approval from the PHO, CHD 3 and LGUs have been secured, these facilities shall undergo facility improvement to include procurement of new equipment, furniture and other fixtures. The process will be undertaken by the RHUs to comply with PHIC accreditation requirements for MCP. A basic training package, prepared for BEmONC staff, will be conducted. Non-BEmONC health care workers will be given training on Life Saving Skills and BEmONC. The Women’s Health Teams in all municipalities and cities will be oriented on the BEmONC facility and how pregnant women can avail of its obstetrical services. Other safe motherhood training and orientation courses will be provided as needed. Procurement of FP commodities under the LGUs’ approved CSR+ Plans shall be implemented fully. Full implementation of the CSR+ Plans will involve the budget appropriation of the local legislative councils of the different municipalities and cities in the province. In 2008, 19 LGUs have had already allocated budget for FP but only 17 procured FP commodities. Paombong, San Miguel and Malolos City will be encouraged to finalize its CSR+ Plans to ensure availability of FP commodities to current and new users. While it is true that not all LGUs can procure and provide for unmet FP needs of its constituents, efforts will be undertaken to generate resources outside of the LGU IRA-dependent budget. One possible source of funds is the MNCHN Grant that provides funds for FP programs and activities. CSR+ Plans will be regularly monitored and evaluated to pinpoint out weaknesses in program implementation. In this regard, BHWs and other frontline workers involved in the FP program will be oriented on the new and improved CBMIS. The CBMIS determines actual FP unmet needs and classifies clients and their ability to pay-for use-service. RHMs will also be oriented on LMIS. Corresponding forms and reporting formats will be discussed thoroughly to capture all pertinent data in the conduct of the CBMIS and LMIS. The MHOs/CHOs shall directly supervise planning sessions with BHWs and RHMs through the conduct of regular Family Planning Action Sessions [FPASs]. These sessions surface out everyday problems and issues in program implementation. Immediately, options are presented as possible responses. PHNs, in charge of data consolidation, will undergo refresher course and mentoring on monitoring and evaluation of priority health programs. Health promotions on modern and traditional FP methods will be aggressively pursued. The PHO will ensure adequate supply and availability of popular, reader-friendly FP IEC materials. Current and new health personnel will undergo CBTFP Level 1 and 2 training, interpersonal communications skills building, counseling and other courses that will facilitate FP program implementation on the ground. With a high maternal mortality in the province, pre-natal care for pregnant women and ante-natal care for post-partum women will be implemented with renewed vigor by health workers. One strategy is to slowly and repeatedly elaborate and persuade pregnant women on pre-natal and ante-natal care. Individual counseling to pregnant women coupled with regular visits by health workers will go a long way in effecting good health-seeking behavior from among women in general and pregnant women in particular. With technical assistance from the PHO, CHD 3 and communication experts, IEC materials and messages will be developed targeting change of behavior of pregnant and post-partum women. These IEC messages will lead pregnant women to have at least four [4] pre-natal visits to the health center for check up and to determine possible pregnancy complications for immediate referral to higher medical facilities. Health workers and BHWs will also be trained in birth planning to facilitate birth planning with pregnant women. This is to encourage pregnant women to deliver their babies in health facilities, attended by professional health birth attendants. Women clients will be oriented and trained on Community-Managed Maternal and Newborn Care to increase number of pregnant women delivering in health facilities. RHU personnel and BHWs will continue informing women on the importance of iron and Vitamin A supplementation to both mother and child. Providing tetanus toxoid shots, Vitamin A and other micronutrients to pregnant women and lactating mothers will be continued by the RHUs. LGUs will ensure adequate supply of these commodities to avoid supply depletion. Efforts will also be exerted to persuade private hospitals to comply with standard tetanus toxoid immunization for pregnant women. In an effort to strengthen inter-LGU cooperation, the PHO in cooperation with the different LGUs will activate the Unified Local Health Systems in the province. The ULHS shall convene from the different RHUs and district hospitals a ULHS-wide Maternal Death Review Committee [MDRC] to analyze maternal deaths and make appropriate recommendations to avoid deaths in the future. MDRCs shall also be constituted in each LGU, with the concurrence of the local legislative councils. Dental health care shall also be encouraged from among pregnant women. IEC materials on dental care will be distributed in the health centers. BHWs will conduct community assemblies and individual counseling to pregnant women on dental health care. Focus will be given in increasing awareness of adolescents on their reproductive health. In 2008 there were more than 2,500 cases of abortion admissions in both private and public hospitals. The health sector, led by the PHO and with the cooperation of the local health boards across LGUs, shall initiate a study on the causes and factors increasing the number of abortions. In the absence of this study, efforts will be undertaken to formulate a program on teen pregnancy. Part of this program is to increase awareness of teens and young adults on adolescent reproductive health [ARH] through the conduct of Responsible Youth towards Life Ready for the Future [RYT Life] in partnership with the PYSEACO. Under the initiative of the Private Health Desk [Schools and Universities Sector], exploratory meetings will be conducted to discuss issues, problems and explore possible programs for ARH, one of which can be integrating ARH into the school curriculum. Efforts will also be undertaken to conduct health education, particularly ARH in public secondary and tertiary schools in the province, in partnership and coordination with the DepEd. 2.5. Healthy Lifestyle and Management of Health Risks 2.5.1 Healthy Lifestyle Management A technical working group for non-communicable diseases [NCD] at the provincial level shall be formed to tale the lead in the formulation of a comprehensive NCD Control and Prevention Program. It shall review past NCD programs implemented in the province, municipalities and cities. RHUs, in coordination with the PHO shall likewise assess past, even disparate, NCD program implementation. Planning will take into consideration weaknesses and strengths from past program implementation. Plans formulated should include provisions for the operation of the NCD HL program, that is, provision of NCD medicines, diabetes drugs [insulin shots] among others. The PHO, in consultation with the concerned LCEs and RHUs, shall hire or designate from among existing plantilla NCD Control and Healthy Lifestyle [HL] Coordinators. These coordinators shall then be oriented on the installation of NCD HL program in their respective areas. A series of stress management seminars will be conducted for health workers so that they may be equipped on the causes, control and management of everyday life, which they can share, through counseling, with clients. Special focus will also be given in the training of health workers to conduct stress debriefing among community residents. Health workers will be trained on risk factor assessment of lifestyle-related diseases, i.e., diabetes, heart problems, obesity among others. Health promotions at the community level will be regularly conducted, citing that majority of the ten [10] leading causes of mortality and morbidity in Bulacan were lifestyle-related. Health education sessions will enlighten the community on the various causes of NCD; thus, they will refrain high risk behaviors. Projecting the importance of practicing healthy lifestyle in the media will maximized during local and provincial events. Meanwhile, LGUs and barangays will be encouraged to form/activate NCD-based programs, e.g., HATAW, diet counseling, smoking cessation, substance abuse among others, from among its employees so that it may influence its constituents to do the same. Existing diabetic clubs and other like-minded groups shall regularly meet and provided with updates on the latest health bulletins and advisories. Anti-smoking campaign will be conducted in high schools and colleges to inform students on the health risks of smoking at a young age, or any age for that matter. NCD-HL information system on various shall be enhanced to include updating of the various NCD-based registries, i.e., cancer, DM, HPN, Redcop. RHUs will be trained in the conduct of registry, its validation and monitoring systems. Sessions will also be conducted for the development of HL performance indicators and monitoring instruments that shall be rolled out to the all LGUs. Parallel efforts will be exerted in strengthening existing referral systems within the public health system and with the private health sector. 2.5.2 Risk Factor Screening Prevention of NCD from among the general population shall be aggressively pursued in Bulacan. This entails massive information drives and health promotions activities to lead people to undergo regular risk factor screening for early disease detection and management. GHU HEPOs with the assistance of BHWs and barangay officials shall take the lead in organizing community assemblies for dissemination of information on NCD causes, detection and management. BHWs, mostly in the communities, will be trained in BP taking so that they could screen as many people for high-blood pressure and other heart-related diseases. Additional BP apparatuses shall be procured as part of the BHW basic kit. Health workers will also be trained in the conduct of self-examination for breast and cervical cancers. Equipment and adequate supplies for these procedures will be procured by the LGUs to ensure continuity and regularity. Other training for risk factor screening will be conducted upon availability of funds and the procurement of equipment. Data collection and analysis across the various non-communicable diseases shall be collated and analyzed as input to future planning. Some these data are from HPN and cardio patients, diabetic clubs among others. 2.5.3 Voluntary Blood Donation Voluntary blood donations existing in the three [3] municipalities shall be continued and will be expanded in the other 21 LGUs the province. Social marketing activities will be conducted in private establishments, public offices and the general population on the need for voluntary blood donors. Blood donation teams will be formed from among the public and private sector to recruit community residents as regular blood donors. RHUs in the 21 expansion areas shall be oriented in blood donation guidelines and trained in basic phlebotomoy Part of the guidelines is the setting up of the Integrated Blood Banking Information System as a registry of all blood donors in the areas. This entails the procurement and set up of computer and reliable internet connection. Also, the Samahan Magkadudugo will be activated in the municipalities and cities of the province. With these processes in place, the Dugong Bagong Bulakenyo or the registry of voluntary blood donors will be completed and regularly updated. LGUs will be encouraged to invest in blood typing and blood transfusion equipment and supplies so that it could mobilize community volunteers, at 10,000 blood typing units per year, for blood donations. Blood transfusion service in the district hospitals will be re-activated. Hospital management will designate from its staff that will manage blood transfusion activities. Activating hospital-based blood transfusion will ease up the blood donation load at the RHUs. Further, hospitals are already equipped to handle this procedure. Five [5] district hospitals will purchase five [5] units of blood refrigerators as storage for donated blood from its own transfusion committee and from the RHUs with no blood refrigerators. The Provincial Blood Center shall also upgrade its equipment and improve existing facility. The PHO in coordination with LGUs and the chiefs of hospitals shall ensure that monitoring, utilization and progress reports are regularly submitted. 2.5.4 Water and Sanitation The PGB, under its Agapay sa Barangay’s Oplan Bantay Palikuran project, shall validate indigent households with no sanitary toilets and proceed to provide free toilet bowls with the family giving their labor as counterpart. Other funds will come from LGU local budget allocated for this purpose. Meanwhile, children and mothers will be informed on proper personal hygiene practices to avoid illnesses associated with unsanitary surroundings. Getting legislative support for increased access of households to safe and potable water will be pursued. Barangay Waterworks Associations [BWSAs] and Local Water Utilities Associations [LWUAs] will be mandated/directed to increase steadily over the years coverage of their service areas, even to unprofitable sections of the municipalities/cities. At the same time, the RHU in partnership with the BWSAs and LWUAs shall regularly conduct water testing to ensure safety and potability of drinking water used by households. LGUs will allot budget for the procurement of materials and supplies needed for water sampling and testing. It shall also procure chlorine granules for one [1] percent of the total residences and 100% coverage of resettlement areas. Environmental sanitation laws and regulation shall be strictly enforced by the LGUs, through the rural sanitary inspectors [RSIs]. Households and commercial establishments shall be encouraged to follow environmental and sanitation ordinances to avoid the occurrence of diseases. Municipal and city officials, including newly hired RSIs shall be oriented and trained on relevant environmental and sanitation laws [PD 856 and PD 522]. RSIs shall regularly conduct inspection of all food establishments have the necessary sanitary permits and that its workers have updated health certificates. This is to ensure that all food being commercially sold in the province are safe for human consumption. A rating system shall be developed and complying establishments shall have the seal of approval prominently displayed on their doors. Efforts will be undertaken for the clean up of critical waterways from toxic contamination. The PGB, with experts from the Environmental Management Bureau [EMB] of the Department of Environment and Natural Resources [DENR], shall validate extent of metal contamination of waterways in ten [10] municipalities and cities and make the necessary recommendations and actions points for implementation. Manufacturers found violating environmental laws and not following their waste disposal management system shall primarily shoulder the cost of clean up. Health workers from affected LGUs with specialists from the PGB shall undergo training on basic toxicology. A surveillance system for heavy metal poisoning shall be established. Communities from the source to downstream of contaminated water shall be informed on the hazards due to metal contamination. Communities shall also be informed of the basic steps to be taken once contaminated water is induced, treatment procedures and facilities. The provincial and district hospitals will also be trained and equipped for the treatment and management of patients with heavy metal poisoning. 2.6. Surveillance and Epidemic Management System Surveillance systems shall be installed and functional to cope with the emergence of old and new, mutated diseases in the country. Surveillance systems act like sentinels, giving people adequate time to prepare before the full force of epidemics strike the general population. Existing surveillance system for dengue and malaria in the various LGUs shall be strengthened and enhanced to include other diseases while preparatory installation activities will be conducted in LGUs without existing surveillance system. Health workers in all RHUs shall be trained on basic epidemiology to update them on standard clinical management of diseases and be updated on emerging and re-emerging diseases. Disease surveillance officers and coordinators shall also be trained on the Philippine Integrated Disease Surveillance and Response [PIDSR]. The PIDSR had been hailed as a responsive and effective disease surveillance system by linking efforts of government and multiple stakeholders in adequately protecting the people from the destructive health, economic and social impacts of epidemics. Towards this end, functional M/CESUs will be re-activated and established in all RHUs, with identified and designated focal person who will take the lead in disease surveillance. Communications equipment like internet-capable PCs shall be installed in the RHUs for the exchange of information with concerned agencies and hospitals. A Bulacan Provincial Epidemic Management Committee will be formed and will formulate a province-wide comprehensive epidemic management plan. The draft plan will be presented to the Provincial Health Board and the Sangguniang Panlalawigan for approval and budget allocation. Highlights of the approved plan will be discussed with the different LGUs and RHUs to give them an understanding of the roles each unit will play when epidemic strikes. Coordinative mechanism with private physicians and health facilities will be strengthened to facilitate referral of patients in epidemic cases. Information systems, e.g., monitoring tools and reporting schedules shall likewise be standardized to facilitate flow of information from source to decision-maker. Regular consultative meetings will be conducted with the group to flesh out coordination issues and in general management of epidemic. Meanwhile, investigations on reported cases and regular surveillance activities would be conducted at the community level. 2.7. Disaster Preparedness and Response System The PGB, through the PHO, shall create a technical working group [TWG] tasked in the drafting of a comprehensive province-wide health emergency preparedness, response and recovery plan. The TWG, as part of the planning process, shall map out and identify disaster-prone areas, extent of past damages, mitigating measures undertaken and level of preparedness organized in LGUs in disaster response. Health workers and volunteer disaster workers will be trained on basic life support, first aid administration and other emergency, first-in-line procedures in coordination with the Philippine National Red Cross [PNRC] and the PDMC. LGUs, with the approval of the legislative councils, shall procure adequate medicines, equipment, consumables and other commodities needed in emergency situations. 2.8 Health Promotions and Advocacy Health promotions across different priority program health areas, dengue and malaria, non-communicable and lifestyle-related illnesses; TB, maternal and child health among others will be initiated. For 2009, a health theme will be the focus for each month. Other promotional activities like “May K sa Health Center” [Kalinga, Kakayahan, Kalinisan, Kaalaman at Kalusugan], health caravan, video showing will also be conducted in the different municipalities for maximum exposure. Health exposition featuring healthy lifestyles will be established in booths during municipal/city events. Research on past health promotion activities will be conducted to draw lessons and its effectivity in changing client behavior. Results of the research will be an important input in the planning of a comprehensive health promotions program for the province across all priority health programs. Capacity building activities for health promotion officers [HEPOs], health workers and BHWs will be conducted such as Trainers’ Training on Interpersonal Communications and Counseling, Community Mobilization, Message Development, IPCC for Service Providers and BHWs, among others. Efforts will also be exerted in the organization of support groups for health promotions activities initiated by the PGB. Media groups will be regularly updated on PGB and LGU health activities for possible coverage and in-depth analysis of health issues being addressed by the public health sector. 2.9. Health Facilities Development 2.9.1 Facility Development At the core of developing public health facilities in the province of Bulacan is the issue of delivering quality health care services to where it is most needed. In this regard, policy makers from the LGU executive and health implementing units shall map out existing health facilities with existing and projected needs, and flesh out a rationalization plan. Only when this process is done that public health facilities in the province, with funding support from their respective LGUs, will undergo facility development to better provide quality health care services to the people, particularly the poor. The PHO, in coordination with the RHUs and technical assistance from the CHD 3 Quality Assurance division will conduct assessment of facilities and make the necessary recommendations for action. Improvements will be instituted not only to comply with the upgrading of health centers into Basic Emergency Obstetrics and Newborn Care [BEmONC] facilities but also to comply with DOH’s Sentrong Sigla certification and PHIC’s accreditation requirements to offer basic medical packages, i.e., Maternal and Child Package, TB-DOTS Package, and Out-Patient Package. Particular attention will be given in providing outlying barangay health stations with the basic and minimum health equipment. As is, 50 additional barangay health stations are needed to be established in strategic areas to reach out to more clients not reached by existing public health facilities. Clients, particularly the poor, do not have to travel far and spend transportation money to go to the main RHUs because clinical and diagnostic services are available in their area. This is indicative that primary health is in the hands of the people. Executive and legislative support for the establishment of BEmONC in pilot sites will be gathered, to include funds for operation and other maintenance costs. Understaffed public health facilities will be filled up through funding supported by legislative intervention. Referral system will also be enhanced to facilitate flow of client patients from outlying health facilities to the BEmONC facility. Capacity building activities will be provided to BEmONC health workers. Efforts will also be undertaken to sustain and expand the number of privately owned birthing stations in the province. Public health facilities will also undergo facility improvement to become birthing stations. Private and public birthing homes will meet all DOH certification and PHIC accreditation requirements. The PHO, in coordination with the CHD 3, shall make representations with the LGUs for the recognition of the RHUs in the municipalities of Marilao and Santa Maria and in Meycauayan City. Clients and patients will flock to the facilities if the seal of recognition is given, meaning that the center is providing quality health care. At the provincial level, the PHO, in coordination with the various local health centers and the CHD 3 shall enhance existing information systems. There is a need to standardize monitoring instruments and reporting forms to facilitate data collection and analysis. Not all public health facilities are conscientiously following established reporting guidelines, much more within the private health sector. This management information system gap impacts on the referral system within the health sector in the province. Parallel activities will be undertaken with key hospital/clinic officials and the PHO/RHUs to strengthen referrals system. The Bulacan Medical Center, the province’s premier public hospital will construct an additional building and renovate existing facilities to better provide quality health care services to the population. Layout of service divisions and offices will be rationalized to ease transaction procedures conducted in the premises. Comprehensive Emergency Obstetrics and Newborn Care [CEmONC] will be established in secondary and tertiary-level health facilities. Once the PHO and the DOH/CHD 3 has identified CEmONC site/s, training will commence for concerned health personnel. All public hospitals in the province will undergo transformation to become integrated centers of wellness, providing quality health care to secondary- and tertiary-level patients. Efforts will be continuously undertaken to make the provincial and district hospitals comply with DOH standard for health care management, that is, sending patients home treated and relieved of illnesses. This means strengthening current capacities of hospitals in maternal and child health. Hospitals will also undergo self-appraisal to determine areas of improvements. Selected hospital-based personnel shall be trained in providing health education [as preventive measure] to clients/patients as part of its wellness program. Hospitals will also establish proper waste disposal management system, particularly for pathologic and infectious wastes. Currently, the six [6] district hospitals do not have disposal system for its liquid waste. Equipment and other materials will be purchased for this purpose. With the rising cost of expenses and finite budgetary allocations from the national and provincial governments, the district hospitals will be encouraged to be self-sustaining units, meaning, able to recover costs and able to create profit margins. Said margins will be used to finance facility improvements and expansion of medical services, higher training courses for hospital-based staff, community extension work, among others. A technical working group will be formed from among members of the different hospitals to explore preparatory processes leading to the corporate set up of the hospitals. 2.9.2 Health Human Resource Strengthening |