General Description of the aop health Situation as of end of 2008

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Part of the facility mapping process is conducting an inventory of all health personnel, looking into individual core competencies and work performance. Short of formulating a major re-organizational development plan, the PHO in coordination with the MHOs/CHOs will conduct appraisal of health staff viz. health needs and the health sector reform agenda.
Almost if not all the RHUs and CHOs in the province are lacking in health personnel to effectively reach out to all its constituents. At present, current provincial population needs an additional 85 doctors, 100 dentists, 85 nurses, 91 rural sanitary inspectors, 50 rural health midwives, and 106 medical technologists. LGUs, particularly the cities and the municipalities with huge population, will be encouraged to create additional plantilla positions for health personnel not only to meet the DOH standard of health worker to population ratio but also to better provide quality health care.
Key health officials will be trained on strategic management to provide them the necessary skills in managing area-based health programs and health sector reform agenda. Equipped with strategic and social development skills, health officials will not only be specialists in their chosen medical fields but can also link health programs to the overall goals of human development.
Newly hired and current health personnel: doctors, nurses, midwives and BHWs will be provided with the basic training and orientation courses on priority public health programs and projects. A series of training sessions on planning, monitoring and evaluation [PME] will be conducted for all program coordinators. All health staff will undergo training on data collation, validation and analysis as input for decision-making.
2.10. Health Regulation
LGUs and RHUs will be at the forefront of ensuring the strict enforcement of health and health-related national laws and regulations and enactment of local legislations supporting such mandates such as the Asin Law, no smoking in public places, environmental sanitation and the ecological waste management law, among others. The PHO in coordination with other agencies and entities shall also develop a policy-tracking mechanism tool to monitor the implementation of health and health-related ordinances.
Towards this end, education and promotional activities will be conducted to inform the public on the different health laws, legislations, and administrative orders among others. The local health boards shall take an active role in the dissemination of this information and recommend possible sanctions for violations and non-compliance.
Existing Botika ng Barangay establishments will continue to operate, and expand its business operations whenever possible to ensure access to quality and affordable health goods and services, especially the poor and in areas reached by indigenous tribes of Aetas and Dumagats; while efforts will be undertaken to establish additional Botica ng Barangay in identified strategic barangays. Financing schemes for community-based drugstores will be explored with the CHD 3 and the PGB for poor communities.
2.11. Health Financing
The increasing population in Bulacan puts a strain to the PGB’s already limited financial resources. At present, the public health sector is in competition with other local public offices for budgetary allocation. While the demand for quality public health service is growing, the budget is getting smaller. There is a need therefore for the public health sector to take an active role in resource generation outside of its traditional fund sources.
For the 2009 Annual Operations Plan [AOP], steps will be undertaken by the PHO and the local finance committee to ensure that the AOP is integrated into the 2010 Annual Investments Plan [AIP] and provided with adequate plans. Upon completion of this plan, the PHO will submit and get feedback from the Governor’s Office. The Governor will then convene the local finance committee and chiefs of hospitals to deliberate and agree on the highlights and salient points of this plan. The Governor and the PHO shall likewise solicit the approval of the Sangguniang Panglalawigan for the 2009 AOP. At the local level, the PHO will coordinate with the LGUs and RHUs for the availability/absence of funds. Funding deficit will be sourced from donations, grants, government agencies and government-owned and controlled corporations.
Once approval has been generated, the local finance committee in coordination with the PHO shall commence its budgeting and cash programming. This process involves the prioritization of activities and procurement schedules so as to avoid cash outages. Parallel processes will also be undertaken at the local level.
Aside from the usual income retention from the operation of health facilities, LGUs will explore and develop mechanisms to generate new sources of funds. A technical working group will be formed from the PHO to carefully study and explore the feasibility of converting health facilities to economic enterprises, among others. LGUs shall also take advantage of grants and other assistance particularly with respect to capacity building for its health workers. The PGB will likewise continue to look for donors to put investments in the Bulacan public health sector, particularly in the enrollment of indigent households to PHIC’s Sponsorship Program. Towards this end, the PGB and the LGUs, in coordination with the Provincial and Municipal/City Social Work and Development Officers, shall identify and validate indigent households for enrollment. Once enrolled, members will be encouraged to patronize health packages offered at the health facilities to maximize the services offered by the social insurance mechanism. In turn, capitation funds accruing to the LGUs will increase to fund other health programs needing financing.
The importance of PHIC accreditation of public health facilities cannot be over-emphasized. Without accreditation, LGUs will continuously drain its limited resources in delivering health services to its constituents, even if it is possible to receive health reimbursements in the form of capitation funds. LGUs will therefore be encouraged to comply with PHIC accreditation and renewal requirements for maternal and child, out-patient and TB-DOTS packages.
While the PGB actively seeks for new and creative sources of health financing, it shall also optimize the efficiency and effectiveness of local financial planning in health by focusing resources on priority programs and implementing performance-based budget allocation. The LGUs shall impose such measures in improving efficiency in resource allocation across levels of healthcare (primary, secondary and tertiary) with strong emphasis on public health.
The first step shall be the conduct of a systematic review/study of the various financing options mentioned to include maximizing PHIC capitation funds for the improvement of health services and facilities. Since the capitation/reimbursement was a stable source of health financing in the province, the LGUs shall continue to improve fund management and utilization of the same for the improvement of priority public health programs and projects. Towards this end, the TWG will explore the possibility of setting up a local health account and the conditions thereof for its utilization and disbursement.
2.12. Health Governance
For 2009 and in line with the health sector reform agenda, the overarching goal of the PGB in health governance is the installation of a functional local health system at the LGU and ULHS that is responsive to the health needs of the people especially the poor. Towards this end, consultation meetings/dialogues and action planning between LGU LCEs and the PHO/MHOs/CHOs will be regularly conducted to synchronize health sector reform efforts.
The three [3] strategies of capacity building for health workers, organization and strengthening of the health boards at the local level and unified local health systems at the district level, institutionalization of management information systems in all levels of operations and decision-making will be implemented by all LGUs and the PGB.
To ensure functional local health systems in Bulacan, the following interventions shall be undertaken: establishment of mechanisms for inter-LGU collaboration through the Provincial Health Board and the Provincial Development Council as venues to discuss cross-cutting health concerns, strengthening CSO/NGO/private sector participation in health development, policy formulation on utilization of information technology in routine recording and reporting, re-orientation on the two-way referral system of public health facilities with primary, secondary and tertiary hospitals, enhancement of capabilities of health service providers in supervision and monitoring, design and implementation of continuing program to train staff in health sector reform priorities and strategies, provision of client feedback mechanism, and development of plan to address out-migration of health personnel to include incentive schemes
The PGB’s procurement process will be streamlined to synchronize with the budgeting and cash programming formulated by the local finance committee. This streamlining and synchronization will improve efficiency and effectiveness of financial, procurement and logistics management systems to support health program implementation are ensured. Innovative approaches to create a positive environment for better financial, procurement and logistics management systems in the health sector through the appropriate mix of incentives and controls will be explored. Procurement standards shall be strictly implemented to ensure integrity of financial transactions and material management processes.

3. Major Thrusts of the AOP

The 2009 Annual Operations Plan will focus on filling up the critical gaps and deficiencies in health service delivery that surfaced out in the crafting of the 5-Year Province-wide Investment Plan for Health.
The AOP will put premium in the building of capacities of the province’s health personnel, from the volunteer health workers, BHS and RHU staff, government hospitals and the PHO. It shall also make representations with the different LCEs and legislative councils for the hiring of additional personnel to critical positions to facilitate the delivery and management of health services to the people of Bulacan.
Existing programs shall be continued while efforts will be undertaken to fill in gaps and respond to weaknesses in the areas of service delivery, financing, regulation and governance. As the AOP is considered the first phase of the PIPH, efforts will be undertaken to popularize the plan among LCEs, legislative bodies, and the community in general to generate support. For the LGUs, support will be translated into funding portions of the needed resources.
These resources will mainly in the form of commodities, equipment and supplies needed for the different health programs being implemented in the different municipalities and cities of Bulacan. Procurement system and logistics management will also be strengthened and enhanced to be able to keep abreast with the needs of the areas, as they happen, where they happen.
Working relationships with decision and policy makers will be strengthened. The AOP has a number of important proposed legislations and policies needing the approval and/or concurrence the local chief executives and members of the local health boards, Sangguniang Bayan and the Sangguniang Panglalawigan. These range from budget allocation to designating no-smoking areas in public areas.
Referral systems across health programs and between the public and private health care sub-sectors will also be reviewed, revised, strengthened and enhanced.
4. Performance Indicators

Goal	2008 Baseline	Performance Indicators	2009 Target
PPA – Disease-Free Zone Initiatives
Rabies Elimination Service
To decrease animal bite cases from 8,697 by 50% of 2008 cases Rabies-free Bulacan	8,697 animal bites seen 3,377 given exposure treatment 6 human rabies deaths	LGU officers conducted house-to-house campaign for responsible pet ownership: registration and dog immunization	21 MAOs and 3 CAOs 21 MHOs and 3 CHOs 569 Barangay Captains
		Ordinance on responsible pet ownership passed and strictly enforced	21 municipalities and 3 cities
		Conducted health education on rabies prevention and control	24 LGUs 57 RHUs 569 barangays
		Provided IEC materials on rabies prevention and control	24 LGUs 57 RHUs 569 barangays
		Rabies Task Force activated and with formulated plans	21 municipalities and 3 cities
		Rabies program regularly monitored	Monthly reports by LGUs and quarterly monitoring by program coordinator
		Category 3 drugs, PET+AERIG, for animal bites provided by LGUs	Bite victims provided with PET+AERIG anti-rabies drugs
		Anti-rabies vaccines provided free to indigent bite victims	5% or 435 indigent bite victims provided with free vaccines
		Animal bite center established	Animal bite center established at the PHO Public Health Office
Leprosy Elimination Service
To reduce leprosy cases from 13 cases to less than 1 per 10000 cases	13 cases or .04/10,000 population	Provided IEC materials on leprosy detection, treatment and management	21 municipalities and 3 cities
		Provided free anti-leprosy drugs [MDT] for patients	12 patients provided with free MDT drugs
		Leprosy elimination program regularly monitored	Monthly reports by LGUs and quarterly monitoring by program coordinator
Malaria Elimination Service
To reduce malaria morbidity from 30/100,000 population to 2.6/100,000 population	Annual Parasite Incidence of 30/100,000 population 30 total positive cases	Health personnel trained on malaria management	14 physicians and 13 nurses from 5 endemic LGUs trained on malaria management
		Vector control materials i.e., treated bed nets provided to households [800 and 940]	Insecticide-treated bed nets provided to 940 indigent households with malaria
		Laboratory supplies provided	500 glass slides for malaria microscopy procured
		Deployed border operations	IRS on borders deployed
PPA – Intensified Disease Prevention and Control
Tuberculosis Control Service
To reduce TB mortality from 369 to 295 cases or 20% reduction [5th on 10 leading causes of mortality]	CDR – 54% CR – 82%	CDR – 70% CR – 85%
	CDR – 54% CR – 82%	TB Patrol expanded	TB Patrol expanded in strategic barangays of San Rafael and Guiguinto municipalities
		PPMD formed and members trained on TB referral system	PPMD established in Obando and Plaridel Private physicians from Obando and Plaridel trained in PPMD
		Provided anti-TB drugs for Category 1 & 3	2,088 smear positive cases provided with anti-TB drugs for Category 1 & 3
		Provided anti-TB drugs to children with TB	104 children with TB provided with anti-TB drugs
		TB microscopy supplies procured	Laboratory supplies provided for TB microscopy: acid fast stain, glass slides, re-agents, PPD
		Provided anti-TB drugs for inmates	16 inmates provided with anti-TB drugs
		TB control program regularly monitored	Monthly reports by 57 nurses and quarterly monitoring by program coordinator
		Private microscopy laboratories involved in TB control program	5 private diagnostic laboratories trained in standard TB-DOTS microscopy
		Health facility assessed for TB-DOTS accreditation	RHUs of Angat, Guiguinto, Santa Maria and Baliuag municipalities assessed for TB-DOTS accreditation
		TB Diagnostics Committee activated	2 consultants [radiologist and pulmonologist] hired for TBDC to strengthen quality assurance of microscopy services
		TB in the Workplace initiated	3 private companies implementing TB in the Workplace program with 90 workers oriented and trained on TB detection and control [30 workers/company]
HIV/AIDS/STD/STI Control Service
Transmission of HIV/AIDS and other reproductive tract infections are contained and their impact mitigated To reduce +GC from 123 to 62 (50%) by 2013	123 +GC or 0.03/ 100,000 population	50% reduction of + GC
	123 +GC or 0.03/ 100,000 population	High-risk areas mapped and assessed	9 high-risk municipalities and cities mapped and assessed “hot spots” and commercial sex workers
		Ordinance legislated	LGU local health boards convened LHBs in 9 high-risk areas with passed legislation/ordinance on STD/STI control with provisions for the procurement of medicines, laboratory re-agents and other supplies
Dengue Control Service
To decrease dengue cases from 1,548 on 2008 to 929 [60%] by 2013 To decrease CFR from <1% to 0 CFR [17 deaths to 0 death]	<1% Case Fatality Rate [CFR]	Formed of vector control groups in schools leading to dengue-free schools	Organizing of Dengue Skul Watch Teams in 50 private and public elementary and secondary schools Principals, teachers and student body oriented and trained on dengue prevention and control Insecticide-treated curtains provided to schools IEC materials on dengue distributed to schools and homes of students
		Trained health workers on dengue vector control and entomology	57 rural sanitary inspectors and 24 BHWs trained on dengue vector control and entomology
		Mobilized community residents for house-to-house vector control	25% of 569 barangays and 584,395 households underwent dengue vector control through “search and destroy” of dengue habitat and breeding sites and defogging operations
PPA – Child Health
Reduction of infant and under 5 mortality from 5.76/1000 live births to 2/1000 by 2013	86% coverage of fully immunized children	Assured supply of immunization vaccines and other supplies	Regular and timely delivery or pick up of immunization vaccines for 2.7% of total population from PGB, LGUs and CHD 3 Assured availability of augmented immunization paraphernalia through LGU procurement
		Clients informed on immunization	High percentage of clients participated in immunization schedules
		Organized and trained peer counselors for breastfeeding	20 breastfeeding mothers from 2 barangays organized and trained on peer counseling for breastfeeding
		Health workers trained on IMCI	30 health workers [nurses and midwives] trained on IMCI
		Immunization program regularly monitored	Monthly reports by LGUs and quarterly monitoring by program coordinator
		LGU procured micronutrients and medicines for sick children	LGUs approved CSR+ plans with line budget for procurement of oresol, zinc and cotrimaxazole for sick children
		Conducted health event focusing on children’s immunization	High number of children immunized under the GP program
		Increased number of households and commercial establishments using iodized salt	Regular inspection of households and commercial food establishments for compliance of iodine salt utilization
		Asin Task Force activated	Convened and activated Asin Task Force at the provincial level for iodized salt compliance
		Oral care program disseminated in LGUs, RHUs and schools and oral hygiene practiced	IEC materials on oral care disseminated 24 LGUs underwent dental prevention and curative procedures
		Private and public hospitals and clinics adhered to Milk Code	Regular inspection of hospitals and clinics complying with Milk Code
PPA – Maternal Health
Reduction of maternal mortality from 6.82 to 1.71 (2) by 2013 From 44 cases to 11 cases of maternal deaths by 2013		Health facilities assessed and health staff capacity appraised for BEmONC conversion Health facilities assessed for PHIC accreditation for maternal and child package [MCP] and DOH Sentrong Sigla certification	Initiated facility assessment and health staff appraisal in 57 RHUs and 8 PGB hospitals
		Organized Women’s Health Team	Convened Women’s Health Team in the municipalities of Marilao, Pandi, San Ildefonso, Santa Maria, Doña Remedios Trinidad, Pulilian, Baliuag, Balagtas, and San Rafael; and in the cities of San Jose del Monte, Malolos and Meycauayan
		Passed and approved CSR+ Plan with allocated budgets	LGUs of Paombong, San Miguel and Malolos with formulated CSR+ Plan for presentation and approval to LCE, LHB and SB/SP
		Functional CSR+ TWG in the province, 3 cities and 21 municipalities	Regular monitoring of CSR+ implementation, through the CDLMIS, conducted by the TWGs, including the timely procurement and distribution of FP commodities to users
		Increased number of pregnant with at least four [4] pre-natal visits to health facilities	Distribution of IEC materials on importance of pre-natal visits to pregnant women Pregnant women provided with Baby Book Pregnant women with birth plans Conducted health event with focus on safe motherhood
		Provided micronutrients Vitamin A for pregnant women	Ensured availability of and distributed locally-procured Vitamin A capsules to pregnant women
		Increased participation of women on maternal health programs	IEC materials on maternal health distributed to women clients leading to good maternal health-seeking behaviors
		Activated MDRC at the municipal/ city, district/ULHS and provincial levels	MDRC regularly conducting clinical case conferences and reviewing maternal deaths
PPA – Healthy Lifestyle and Management of Health Risks
Risk Factor Screening
Reduced mortality and morbidity due to non-communicable diseases		Formed technical working group for NCD	Convened the NCD TWG to lead in the assessment and planning for a comprehensive NCD control and management program
		Provided risk factor equipment and supplies	LGUs procured 30 units of glucometer and 57 units of strips for diabetic clubs and 118 BP apparatuses for monitoring of heart-related illnesses
		Increased number of blood donation units	16,000 units of blood donated through quarterly mobile blood donations at the RHUs and PGB hospitals
		Increased awareness of community on voluntary blood donations	Held health event giving tributes to LCEs and blood donors focusing on the importance of voluntary blood donations
		Organized and trained local blood council members	Organized 21 local blood councils and trained its members on blood council guidelines
		Equipment provided for local blood center	Purchased one [1] unit of blood refrigerator for one [1] blood center
		Voluntary blood donation and utilization regularly monitored	Monthly reports by LGUs and quarterly monitoring by program coordinator of blood utilization
		Risk factor screening regularly conducting	BP and breast cancer/cyst risk screening conducted by BHWs at the barangay level and health personnel at the RHUs
Water and Sanitation
Increased access of households to sanitary toilets		Toilet bowls provided to indigent household	400 indigent households with access to sanitary toilets
Reduced morbidity rate from diarrhea to 500/100,000 population	740 diarrhea cases per 100,000 population	Water sources used by households tested for potability	50,500 Level 1 -3 water sources tested Chlorine granules provided to RHUs for treatment of water sources 584,395 households in resettlement areas with safe water through the provision of chlorine granules
		regularly conducted monitoring and validation of environment and sanitation reports	57 RSIs and PHO staff regularly conducting monitoring and validation activities
Compliance of food establishments to DOH standards of food safety procedures	10,527 out of 11,806 [89.2%] of food establishments with sanitary permits	Food establishments with sanitary permits	100% of food establishments with sanitary permits
	28,498 out of 31,953 [89.2%] of food handlers with health certificates	Food handlers with health certificates	100% of food handlers with health certificates
		Food establishments rated according to compliance to existing DOH standards and local ordinances	Inspection teams convened with SSRS guidelines enhanced for evaluation of food establishments
	3 waterways confirmed and 7 suspected waterways with toxic contamination	LGU and health personnel trained on basic toxicology and health surveillance	10 LGUs with personnel trained on toxicology and health surveillance
		Conducted assessment of high-risk areas for heavy metal contamination	Assessed 9 LGUs with waterways confirmed and suspected of heavy metal contamination Regularly monitored confirmed and suspected waterways for heavy metal contamination
		Mapping of remaining LGUs for heavy metal contamination and other industrial-related health hazards	Conducted mapping of heavy metal contamination and other industrial-related health hazards in 24 LGUs
		Increased awareness of community residents in high-risk areas on heavy metal poisoning	1 handbook on heavy metal contamination and poisoning drafted, finalized and distributed
PPA – Surveillance and Epidemic Management System
To prevent, control and manage the occurrence of outbreaks on reportable, immunizable disease and other emerging and re-emerging diseases through formation of M/CESU	Non-functional epidemic surveillance units at the municipal and city levels	Epidemic surveillance units convened with trained members	57 RHU and 8 hospital health staff trained in Philippine Integrated Disease Surveillance Response [PIDSR] M/CESUs convened and regularly conducting monitoring work Provincial ESU regularly conducted monitoring visit to LGUs
PPA – Disaster Preparedness and Response System
To reduce mortality from disasters [natural and man made disaster]	Absence of Health Emergency Preparedness Response and Recovery Plan	Ensured availability and accessibility of emergency medicines and equipment	LGUs procured adequate antibiotics, analgesic, anti-diarrhea, anti-hypertensive drugs and vitamins for emergency situations LGUs with available service vehicle for emergency situations
PPA – Health Promotions and Advocacy
90-95% of population are health conscious and increased access to public and private health facilities	Poor health seeking behavior of clients Preference for private health facilities Misconceptions on health and health practices Unavailability of and lack health information materials	LGUs and RHUs provided with different health information materials for distribution to clients	CDs containing health information distributed to RHUs
		Conducted events for increased awareness of health issues and practices	LGUs conducted “Hataw sa Kalusugan” Sportfest building people’s interest to lad good health-seeking behaviors LGUs/RHUs conducted promotions on healthy eating places BHWs federations conducted health updates
		Health workers trained on health promotion and advocacy work	Health workers trained on: Interpersonal Communications Skills Counseling Community Mobilization
		Health promotion materials locally produced	Promotional materials produced: Tarpaulins Streamers Compact discs Leaflets Flyers Calendars and other collaterals News bulletins
PPA – Health Facilities Development
100% of public health facilities are SS-certified and PHIC-accredited	53 RHUs are SS-certified MCP: 1 RHU OPB: 21 RHUs TBDOTS: 12 RHUs 7 PGB hospitals are DOH-accredited	Local health facilities renovated	Renovated 10 health facilities in: Angat Balagtas Baliuag Bulacan Guiguinto Pandi
		District hospitals renovated	7 district hospitals and 1 provincial hospital renovated
Health Regulation
Implementation and enforcement of health and health-related laws and ordinances	80% compliance to health and health-related laws and ordinances	Increased awareness of policy makers and enforcers on health and health-related laws and ordinances	Regularly conducted meetings of the Bulacan Provincial Health Board
	39% or 22 RHUs are OPB-accredited 30% or 12 out of 40 sputum microscopy centers are TB-DOTS accredited 11% or 1 out of 9 RHUs are MCP accredited Low coverage of PHIC enrollees	Increased enrollment of households to PHIC	Meetings conducted with stakeholders: PHIC, MSWDO, residents, and RHU/LGU for funding and enrollment of enrollees
	Inadequate ordinances supportive of national health laws	Increased number of local ordinances supportive to national health laws, department, executive and administrative orders, among others	Information disseminated to legislators Local health boards activated and strengthened Local ordinances passed supportive of national health and health-related laws, orders, issuances among others Monitored regularly compliance to ordinances
	Absence of Health and Sanitation Code	Passed Bulacan Health and Sanitation Code	Formed TWG to take the lead in the crafting of the Code Public hearings conducted on the proposed Code Code approved by concerned legislative bodies for implementation Monitored regularly compliance to codal provisions
Health Financing
Universal coverage for social health insurance	93% of indigent households are enrolled under the PHIC’s Sponsorship Program	Indigent households enrolled under the PHIC’s Sponsorship Program	4,000 indigent households enrolled
PHIC accreditation of public health facilities	39% or 22 RHUs are OPB-accredited 30% or 12 out of 40 sputum microscopy centers are TB-DOTS accredited 11% or 1 out of 9 RHUs are MCP accredited	Public health facilities accredited by the PHIC to provide benefit packages	3 RHUs assessed for facility improvement to comply with PHIC requirements for accreditation
Health Governance
Increased inter-LGU cooperation through the ULHS/ILHZ	6 out of 7 ULHS functional	All ULHS functional	Conducted ULHS assessment and planning through Program Implementation Review of the 6 ULHS Passed LHB/SB/SP resolution integrated private health system with the public health care system Trained LHB members and health personnel on ULHS policies and procedures
		ULHS monitoring forms	Monitoring forms developed
		Appraisal system for health facilities developed and implemented	Conducted recognition activity for best performing and outstanding health care facilities
		Mapping of health care providers across the public and private health care system	Private and public health care facilities and services mapped out and existing data updated and validated
		Trained health staff on BCC	PHO staff trained in Behavioral Change Communications
		Health workers conferences and trainings	Conducted regular health staff meetings and conferences for updates and professional growth
		Institutionalization of CBMIS	Health staff and workers trained in the conduct and analysis of CBMIS
PIPH plan implementation and management		Created PIPH Management Committee or LICT	Convened and oriented members of the PIPH LICT
Health Program Management		Health program evaluation	Conducted regular program implementation reviews of health programs

2009 Annual Operations Plan

Province of Bulacan

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