20th
Year Anniversary
Vol. XV No. 6
November - December 1997
Communities
Help Themselves:
Health Care Initiatives in Mindanao
ISSN 0115-9097
quite recently. As such, it is vital to know and understand what motivating factors led to their establishment. What processes did the organizers undergo to put such set-ups in place? How are such schemes sustained? Can success stories be replicated?
The case study How it all began When Evelyn, a barangay health worker (BHW) in Southern Mindanao was diagnosed as having Hepatitis B, she was faced with the difficulty of having to buy the prescribed medicine which cost a total of P3,289.50.
teers Credit Cooperative, a health care financing organization where she was a member. She was able to borrow an initial amount of P500 to buy a startup dosage of 45 capsules. Eventually, she borrowed money two more times from the cooperative and also sold a small lot to meet the full amount.
In the poverty-stricken area where she lived, most families depended on farming for livelihood and that amount was way above what most people could afford. Fortunately for Evelyn, she got some help from the Malalag Community Health Volun-
Today, in Southern Mindanao, particularly in Region XI, people are organizing themselves in order to avail of affordable health care services. While a number of such organizations have been existing since the 1960s, many others have only been formed
EDITOR'S NOTES In this special issue, we take a break from the usual theme of macroeconomic policies and feature highlights of a major output of the Department of HealthPhilippine Institute for Development Studies (DOH-PIDS) joint project on Baseline Policy Research on Health Care Financing Reforms and recent developments regarding the topic since the completion of the project two years ago. The first article is a condensation of the “Community Health Care Financing in Region XI,” a study done by the Insti-
tute for Primary Health Care-Davao Medical School Foundation (IPHC-DMSF) in 1995 which was subsequently released by PIDS as a Discussion Paper. The study chronicled the identification, organization and implementation of several community-based health care financing groups in the region and the concerns and problems that affected them. In November 1997, a team from the PIDS and the DOH revisited this project with the conduct of a roundtable discussion on “Current Mindanao Initiatives in Community Health Care Financing” held
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With these questions in mind, the Case Study of Community Health Financing in Region XI was conducted to look into this significant evolution of community-based groups offering health care financing schemes. This case study was part of the Baseline Policy Research on Health Care Financing Reforms project undertaken by the PIDS for the Department of Health (DOH) in the early 1990s. It focused on Mindanao initiatives in
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WHAT'S INSIDE 3 6 7 8 9 10 10
Choosing the Case Examples Linking Health Care Schemes: Answering the Challenge of Sustainability Tripartite Link-ups: Toward Better Health Care Sustainability: A Matter of Cold Data and Fiery Commitment Mindanao Local Officials Take Lead in Health Care Programs Staff Outreach Activities Christmas at PIDS
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from Page 1
of 20 percent, the second, 10 percent and the third claim, 5 percent of the fund.
health care financing and was jointly proposed and eventually conducted by the Davao Medical School Foundation (DMSF) - Institute of Primary Health Care (IPHC), one of the pioneering nongovernment organizations (NGOs) that are actively involved in promoting community health financing in Southern Mindanao, and the Development Academy of the Philippines (DAP).
n New Sambog Health & Hospitalization Assistance (NESAHHA) – Half of the funds raised from membership fees is released to a member who gets sick as a medical loan for treatment or hospitalization. The loan bears no interest for the first six months. Forty percent of the fund is added to the general fund of the organization while the remaining ten percent is set aside to purchase medicine tablets which are given free to the members.
Communities Help Themselves ...
November - December 1997
erations and treatment due to accidents and are given free dental consultation and 50 percent discount on extraction and filling. A deposit of P1000, P2000 or P3000 entitles a member to a Medical Guaranty Loan Fund of P5000, P10,000 and P20,000, respectively. n BHW Association of Tacul – The association’s botika sa purok sold medicine tablets with a low mark-up to members of the association. Each member was entitled to a medical loan of up to P200 with an interest of 5 percent. Services, however, have been sus-
Set-ups and benefits In their initiative to organize and set up health financing schemes, the residents thought of various ways of fund generation to be able to provide a number of health benefits and services to those who are in need of them. The seven case examples included in the study had the following features: n Malalag Community Health Vo l u n t e e r C r e d i t C o o p e r a t i v e (MACHEVCC) – Extends loan assistance of up to P1200 from the Social Development Fund for their health care needs. The loan has an interest rate of 2 percent per month. Members and their family may also avail of an emergency medical loan of up to P500 with an interest of 1 percent. Regular members who are not delinquent in paying their monthly contributions receive patronage funds at the end of the year. n Sto. Nino Helping Hands (SNHH) – A member is entitled to a maximum of three claims from the total fund raised through membership fees: the first one allows the maximum
"What became evident was that communities whose members were committed and dedicated in sustaining the scheme had been more successful."
n Medical Mission Group Hospitals & Health Services (MMGHHS) – Essentially a health insurance scheme managed by a cooperative, members may choose from three types of coverage with varying amounts of annual contribution. Plan A requires P1200 a year (P112/month) contribution and entitles the holder to total health care benefits and admittance to the ward section of the Medical Mission Group Hospital. Plan B is for dependents of Plan A holders and costs P1 per day or P365 a year. The benefits are limited to free outpatient consultations and free hospitalization not exceeding P5000 per confinement. Plan C costs P1800 year and offers total health care benefits similar to Plan A but holders may be confined in private rooms of the MMGH. n King Cooperative – Members in good standing are covered for op-
pended due to the inability of members to pay loans and due to mismanagement of records. n KsK sa Barangay – Mortuary aid in the amount of P20 per member was extended to members who have a relative who died. A medical loan was added in 1991 with a maximum amount of P300 interest-free for three months to all members and their dependents. Services, however, were suspended due to unpaid loans.
Can the schemes be sustained? Problems encountered The success of any scheme may be measured by its sustainability in the long run. In this regard, can these case studies (besides those that were mentioned as having had their services already suspended) sustain their efforts to operate?
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The study bared some difficulties in this area: b Difficulty in maintaining the level of commitment from the members. The most common problem cited was weakening cooperation of the members which lead to delinquent paying of loans, absence in meetings, etc. b Lack of initiative among members. For instance, some members of the MACHEVCC were being discouraged by their husbands to put more effort in the organization. b Difficulty in sustaining a viable level of financial capability. With only a small amount of contributions, the schemes serving low-income groups are very unstable. Even the large organizations such as the MMGHHS and King Cooperative are adopting various measures that will ensure that their funds can sustain their health services. What became evident was that communities whose members were committed and dedicated in sustaining the scheme had been more successful. Certainly, members who religiously paid their contributions benefited more from the programs.
Did the schemes make a difference? To assess the impact of the health financing schemes established in the communities studied, residents were interviewed about their health practices before the setting up of the schemes and their behavior and observations after their availment of the services of the schemes. On the whole, the feedback seems to be positive as shown in the following assessment:
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November - December 1997
Choosing the Case Examples With the help of a baseline survey conducted among local government officials and personnel, Barangay Health Workers (BHWs), Department of Health personnel, nongovernmental organizations (NGOs) and community leaders, the study was able to identify 48 health care financing schemes existing in Davao del Norte, Davao del Sur, Surigao del Sur, South Cotabato and Davao City and other areas within the provinces and cities in the region. These schemes used four methods of fund generation to finance their health care services, namely: n Personal pre-payment – One-time or regular contributions are made by individuals and households prior to service need; may be run by beneficiaries themselves or by another group; coverage may be partial or total. (Used by SNHH, NESAHHA, MMGHHS, King Coop and KsK.) n Income generation – Health-related and nonhealth related activities run by organizations for profit to finance health care. (Used by MACHEVCC and BHW Association of Tacul.) n Ad hoc contribution/fund raising – Activities resorted to by organizations to raise revenues to help finance health care. (Used by SNHH and NESAHHA). n Drug Sale – Medicines are sold with a low mark-up to finance health care. (Used by BHW Association of Tacul.) From the roster of 48 financing schemes, seven case examples were chosen to be further studied. The basis of selecting the case examples was grounded on two sets of criteria, namely: Set 1: b have been in continuous operation for at least six months b presence of recipients who have actually availed of the services and benefits b scheme is clearly defined (it has the consensus of the community that it is really in operation and accepted by the community) b availability of records/documents b unique (those whose manner of raising resources or whose services or benefits set them apart from the rest) Set 2:
(When there is more than one case for each type)
b accessibility of the area b most number of members b willlingness of respondents/community to be interviewed
What are the motivating factors? What motivates groups, especially communities, to organize health financing schemes? Is health care always in their list of priority concerns?
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DEVELOPMENT RESEARCH NEWS
Communities Help Themselves ... from Page 3 On health status – Most of the recipients responded that the status of their health improved but cited other reasons other than the health care program. Some cited the presence and accomplishments of BHWs in their communities while others acknowledged the benefits of the scheme that added more health facilities in their areas. On health service utilization – The pooled resources certainly helped members avail of professional health services. Members of the SNHH said that even as the amount of funds offered was very limited and did not even cover hospital expenses, they were still satisfied with the benefits they get. They were even conscientious enough not to avail too much of the medical loan even if they were entitled to it since the others might also need it. In contrast, the MMGHHS management complained that the members
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abused the availment of services and sought help even for very minor illnesses. On health-seeking behavior – Members responded that they became more confident in seeking medical help. Members of the NESAHHA, for instance, said that the availability of interest-free emergency funds was particularly helpful. SNHH members, on the other hand, said that what made the difference was the thought that the others were there to help them in their time of need.
Initiatives undertaken after the baseline study More than two years have passed since the set of studies under the DOHPIDS baseline policy research project, including the case study on community health financing schemes, was completed. A lot has happened in both the environment of the communities studied in Region XI and in the national environment relating to the
Choosing Case Examples ... from Page 3 It should be noted at the outset that the communities studied where the schemes were established consist mostly of low-income and middle-income households. Majority of the residents depend on farming for their livelihood while the others are locally employed. Health care is not normally high on their priority list since most of them could not afford medical treatment and would rather take self-prescribed drugs, herbal medicine or other alternative forms of treatment for their illnesses. However, the communities studied also have a strong sense of volunteerism and cooperation among the residents, anchored sometimes on ethnic backgrounds. For instance, the residents of Sto. Niño, New Corella were mostly Boholanos and were inherently helpful of one another. It was in this self-help attitude of the members of the communities where the initiative to get organized sprung and flourished. At the same time, the presence of barangay health workers made a big difference in the effort of the groups to seek better health services. The participation of local government units and NGOs also contributed to the success of the schemes in the community. DRN
November - December 1997
overall health care financing system. In terms of the Region XI communities, a revisit would show that a number of the 48 identified schemes have stopped operations. This was due to a number of reasons such as the inability of the members to pay their dues and loan payments, failure of the membership base to expand and mismanagement of the schemes, among others. Amidst this scenario, though, a number of positive developments also took place.
Creation of the PHIC Perhaps the most significant was the enactment of the National Health Insurance (NHI) Law on February 14, 1995 and the subsequent creation of the Philippine Health Insurance Corporation (PHIC). Officials of the PHIC admit that the NHI program was spurred by the health care service endeavors in the different rural and urban areas in the country including those documented in the case study of community health care financing schemes in the DOH-PIDS Baseline Research Project. Its mission is to “provide access to quality medical care services to all.” The program intends to achieve universal coverage in 15 years with the first five years aiming to put 25 percent of the indigents under the program. So far, it has been launched in 17 areas across the country, the latest of which is in Dagupan. What is good about the NHI program is that one of its provisions demands the active involvement of the local government units (LGUs) starting from the barangay level. It is the task of the barangays to identify who the indigents in their communities are in order that they can be served. The LGUs must also use their authority and resources to mobilize the residents to participate in the program.
DEVELOPMENT RESEARCH NEWS
In terms of the link-up between the PHIC and health financing schemes, the PHIC notes that there are indeed a lot of possible areas of partnership even if certain rules are still being ironed out. The NHI program, for instance, has an accreditation standard that health service providers must meet to be able to participate.
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cessibility is realized. Thus, in addition to strengthening the capability of BHWs, facilities such as satellite clinics and barangay health stations were upgraded. Equally important, the capability-building component was no longer focused on service provision but also included training on the management of these facilities.
"...there was also a growing recognition that it was important to look for mechanisms to link the community-managed health initiatives to the national health insurance scheme."
The PHIC also intends to upgrade public hospital facilities in order to match the standards expected by the members who are paying for the insurance. The NHI law provides for certain fees to be allotted for this purpose. Furthermore, the PHIC will also give incentives that will attract private hospitals to join the program and private medical practitioners to render service in far-flung areas.
Linking community health financing initiatives with the National Insurance Scheme Based on the developments from the local front that took place after the completion of the original case study, new schemes were set up by nongovernment organizations like the Institute for Primary Health Care in Region XI. Learning from the lessons of the earlier programs that were set up, the new financing program organized was guided by the observation that a community-managed health financing scheme will only be able to increase its membership and payments if the quality of care is improved and greater ac-
The project worked with existing BHW organizations. It was able to keep tabs on payments from beneficiaries, identify the types of services they availed of and determine the program’s impact on access to health and family planning services. But the IPHC also realized that unless the number of members increased, the support for the BHWs will be minimal. As a result, it urged BHWs to learn about social marketing. They advertised the clinics and participated in promotional activities to attract new members and to increase utilization of services. In addition to the efforts put in this new program, there was also a growing recognition that it was important to look for mechanisms to link the community-managed health initiatives to the national health insurance scheme. This link is envisioned to formulate a scheme where the community-based groups can be involved in two ways: first, as the group that will enroll the potential members of the NHI program in their respective barangays; and second, as a local team
November - December 1997
of health care providers with a clinic (and a team of health workers) that is recognized and compensated as a part of the network of service providers.
What was learned? The study of the experiences of the various community health financing schemes in South Mindanao, particularly Region XI, as well as of the experiences of the more recent schemes established after the completion of the DOH-PIDS baseline research project yields a number of insights. First, social marketing is an important component that should be included in a health care financing program. The community is used to getting services for free but its members have to realize that the use of the medical facilities as well as the services of the BHWs (most of whom are poor) have their attendant costs. Second , people join the scheme when they see an improvement in the facilities and quality of the service. They are attracted to join the program when they see buildings erected and equipment brought in. The presence of trained personnel also adds to their motivation to enlist in the project. Third , linkages to the NHI scheme and the local governments enhance the sustainability of the community-based health care financing programs. This was given much credence by Mr. Danny Darroca, barangay captain of Maibo, Tantangan, South Cotabato who heads the federation of BHWs in the province and who, along with several other community leaders, manages the Maibo Bulig-Bulong
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DEVELOPMENT RESEARCH NEWS
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ommunity-based health care financing schemes in the country need to link-up with the national health insurance program in order to ensure their sustainability and further development. This was the view shared by Asuncion Chin, former director of the Institute for Primary Health CareDavao Medical School Foundation (IPHC-DMSF) and Linda Laureta, Head of the Corporate Communications Office and Officer-in-Charge of the Health Finance Standards Division of the Philippine Health Insurance Corporation (PHIC) during a
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Policy Research Project on Health Care Financing Reforms of the DOH-PIDS, the IPHC-DMSF was able to identify 48 health care financing projects in the region using various fund-raising means to finance their health care financing programs. However, after checking on their progress recently, she found that several of these schemes have failed due to a number of reasons such as the inability of members to pay their dues and loan payments, the failure of the membership base to expand and mismanagement of the operations, among others. In light of this, she noted that the sustainability of the schemes has been
Linking Health Care Schemes:
Answering the Challenge of Sustainability roundtable discussion held recently in Davao City. Entitled “Current Mindanao Initiatives in Community Health Care Financing� organized by the Department of Health (DOH), its regional office in Davao City and the Philippine Institute for Development Studies (PIDS), the discussion provided a venue for a number of local government officials in Mindanao, DOH officials, NGO representatives and health care financing experts to get insights on how to institutionalize community health care financing schemes. Chin noted that in the course of conducting the case study on Community Health Care Financing in Region XI two years ago as part of the Baseline
a constant concern of national and local health care groups. The enactment of the National Health Insurance (NHI) law in 1995 and the creation of the Philippine Health Insurance Corporation (PHIC) provided much hope as Chin concluded that one way of ensuring the viability of community health care initiatives is to link them to the national health insurance scheme. This was also one of the policy recommendations of the case study. In order to optimize the potential of the community health care groups, she said that the link should involve them in two ways: first, they should serve as the group that will enroll the potential members of the NHI program in their respective
November - December 1997
Ms. Asuncion Chin, former director of the Institute for Primary Health Care-Davao Medical School Foundation.
barangays; and second, they should be the local team recognized and compensated as part of the network of health care service providers. Laureta responded by saying that the framework of the NHI program precisely intended to encourage grassroots level initiatives and active participation. One of its specific provisions urges local government units (LGUs), starting from the barangay level, to use their authority and resources to mobilize the residents to participate in the program which intends to reach universal coverage in 15 years and include 25 percent of indigents within five years. For this purpose, barangay leaders are tasked to identify who the indigents in their communities are in order for them to be included in the program. Laureta stressed that the cooperation of the communities will serve to bolster and ensure the success of the NHI program as well as their own community-based health care schemes. She also said that tapping these groups to form part of a pool of health care service providers is an idea worth
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H
ealth for All by Year 2000 is a vision that needs a balanced amount of community effort and government and external support in order to be achieved.
November - December 1997
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Tripartite Link-ups:
Toward Better Health Care
This was declared by Maylene Beltran, program manager of the Health Policy Development Staff of the Department of Health (DOH), during a recent roundtable discussion sponsored by the Philippine Institute for Development Studies, the Department of Health and the DOH regional office in Davao City. Entitled “Current Mindanao Initiatives in Community Health Care Financing,” the roundtable discussion focused on the efforts initiated by local communities in Region XI to help the national government beef up resources to finance health care services.
initiating efforts, organizing beneficiaries and establishing health service providers to help community health financing schemes. Aside from mobilizing their communities and maintaining links with other government agencies, local government units “can act as a catalyst in helping depressed areas to work together by allowing people to organize and participate” in health-related activities. It was noted that one of the findings of the previous PIDS-DOH research on these schemes was that a large part of their success depended on the support of the local government.
Beltran said that providing good health to the citizenry is an enormous challenge that the DOH alone cannot do. Thus, it continues to rally the collective effort of the public, private and community sectors even as it seems to have generated a positive response from communities and local residents like those in Region XI. As one of the papers completed in a previous PIDSDOH research project on health care financing reform and presented during this roundtable discussion noted, 48 community health financing schemes in Region XI alone were set up in 1995. These schemes have different structures and mechanisms and offer a varying range of benefits and services depending on the financial capability, social background of beneficiaries and other conditions present in their communities.
Local government units can also provide the much-needed financial support to augment the meager resources of the communities by subsidizing their expenses. Schemes that utilize drug sales as the primary method of fund generation can benefit greatly from the support of LGUs as do the others that incur big expenses.
In light of this development, Beltran called on local government units (LGUs) to take a direct role in
Ms. Maylene Beltran, program manager of the Health Policy Development Staff of the Department of Health.
They can also provide seed capital to organizations that are planning to put up their own health financing schemes and shoulder counterpart contributions so that the schemes can expand their coverage and enhance their benefits. As for the private sector, Beltran said that NGOs and private organizations could provide technical and management assistance to the communities. Keeping records and balancing financial statements essential in monitoring the viability of the schemes are skills that need to be taught the local residents in managing health financing schemes. The NGOs can play a significant role here. Finally, Beltran noted that beyond the link-ups established, there are important underlying issues and questions that likewise need to be addressed. One is how to design an effective health financing scheme. How do we efficiently mobilize beneficiaries or community people to accept and commit to the rules and conditions of the schemes? Another major question is how to ensure their financial viability and sustainability. And, of course, the ultimate question is what has been the impact of these schemes on the health status of the people. Did their health improve as a result of these schemes? While the questions remain to be answered, what is sure is that the challenge and struggle to provide health care should be taken up by all sectors of society. DRN
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Sustainability:
A Matter of Cold Data and Fiery Commitment
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ontinuing research, strong commitment of local govern ment units and constant vigi lance of program beneficiaries are required to help ensure that community initiatives on health care financing are sustained. This was the observation expressed by Dr. Alejandro Herrin, professor at the U.P. School of Economics, as he commented on the reports presented by community leaders, nongovernmental organizations and local government units regarding the experiences and status of communitybased health care financing schemes in South Mindanao, in particular Region XI. Speaking during a Roundtable Discussion on “Current Mindanao Initiatives in Community Health Care Financing” organized recently in Davao City by the regional office of the Department of Health (DOH), in collaboration with the DOH's Health Policy Development Staff (DOH-HPDS) and the Philippine Institute for Development Studies (PIDS), Herrin noted that while it is heartening to see a number of health care financing schemes sprouting in the Mindanao area, there are however certain considerations related to the sustainability of these schemes that need to be studied further. He said that research is necessary to fine-tune and adjust the rules and
conditions being applied in implementing health care programs since they have to contend with human behavior, which is oftentimes difficult to predict. Indeed, according to Dr. Herrin, “the viability and sustainability of the programs depend on the behavior of the beneficiaries and health care service providers.” Dr. Herrin enumerated a number of issues that need to be carefully examined. One was the manner of utilization of service by the beneficiaries. Do some beneficiaries tend to abuse or over-use the services and benefits offered by the health financing schemes, especially for out-patient treatment, to a point that the funds of the organization are almost totally used up? Or do they hardly use any of the benefits available to them? Acknowledging the fine line between abuse and non-use of benefits, Herrin suggested that a constant monitoring of utilization patterns be conducted by the scheme organizers themselves with the intention that people are able to use the appropriate services when they need such. Another issue concerns the need to adopt mechanisms that will ensure an effective collection of member contributions or fees. Since there is a tendency for members' enthusiasm to wear off if they do not get the chance to avail of the benefits of the financing programs, Herrin encouraged the pro-
November - December 1997
gram managers to think of ways to sustain their interest. At the same time, Herrin suggested the setting up of sound management systems that will guarantee the smooth and efficient running of the programs, including the institution of a good record keeping and accounting system. There are also bigger issues that need to be studied further, perhaps by groups outside of the financing organizations, to enable health financing program managers to have information that are necessary for their effective negotiation with health providers. These refer to the study of the true cost of health care services as well as of the behavior patterns of health providers. For instance, it is important to know the real cost of hospital services such as x-ray and ultra sound which are partly subsidized by the government. This information is needed so that the program managers can negotiate for better prices in the hospitals for the members of their organizations. In turn, the hospitals will know exactly how much they will subsidize in the insurance program. Finally, Herrin cautioned about the “danger” that small health care financing schemes face regarding the sudden need to have a large amount of funds if and when majority of the beneficiaries avail of the benefits at once. He said that it is vital to have these schemes protected from such eventuality. Another idea that ought to be looked into further is that of reinsurance wherein the small financing schemes will pay a premium to a bigger organization such as the Philippine Health Insurance Corporation (PHIC) “in exchange for its bailing the small scheme out in case of emergency.” DRN
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T
he national government’s budget for health is never enough to meet the needs of all Filipino families, especially the poor and those living in remote areas in the countryside. Faced with this reality, local government leaders have invariably set up their own health care financing programs in their cities and municipalities. In a roundtable discussion sponsored jointly by the Department of Health and its regional office in Region XI, and the Philippine Institute for Development Studies which tackled initiatives in community health financing schemes, Mayor Justina Yu of San Isidro, Davao Oriental, Mayor Reynaldo Navarro of La-ak, Davao del Norte and Barangay Captain Danny Darroca of Maibo, Tantangan, South Cotabato bared the mechanics of LGUinitiated health care financing programs in their localities meant to help finance the health care needs of their constituents. Mayor Yu established the San Isidro Medicare II Project to supplement the Medicare I program of the national government. Since only workers receiving regular income and salary may avail of the latter program, Mayor Yu’s Medicare II scheme was formulated to serve the members of her municipality who are not salaried such as farmers, drivers, vendors and others. A member only has to pay an annual fee of P240 to avail of medical benefits such as free room and board in accredited hospitals, free x-rays, coverage of medicine expenses from P500 to P700 for ordinary cases and from P600 to P1000 for intensive care cases, subsidized fees for laboratory procedures, and free medical and dental consultation for outpatients, among others.
Mayor Justina Yu of San Isidro, Davao Oriental.
In the municipality of La-ak, on the other hand, local officials adopted an innovative approach in establishing their own health financing program. According to Mayor Navarro, his office worked around the Filipinos’ seemingly large propensity for gam-
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Darroca was organized as part of the Institute of Primary Health CareDavao Medical School Foundation (IPHC-DMSF) joint project. Starting with only 34 families in 1996, more than 100 families now avail of the benefits of the program which include medical and dental coverage in accredited hospitals and clinics for members and their dependents, laboratory tests and consultation. To ensure that these health financing programs are not jeopardized when they leave office, these local officials have put up measures that would institutionalize these schemes. In the case of the San Isidro’s mayor, the management of the program has been delegated to the municipal health officers while in Barangay Maibo, the
Mindanao Local Officials Take Lead in Health Care Programs bling to raise funds. Their approach is to hold regular raffle draws where every barangay in the municipality sells tickets to residents at P20 each. At stake for the winning ticket is P5,000. The proceeds from their ticket sale— at least P10,000—are then used to buy medicine, pay for hospitalization and consultation, and maintain their municipality’s two ambulances. The mayor noted that using this mechanism as a fund-raising scheme avoids the problem of collection among members who fail to pay annual fees when they stay healthy and do not get to avail of the benefits. Meanwhile, the Maibo BuligBulong Program (MBBP) in South Cotabato led by Barangay Captain
barangay captain shares the leadership tasks of the program with other barangay officers. The creativity and commitment of local leaders are major factors in the success of the health care financing programs. As noted in an earlier survey on community health financing in Mindanao, people are encouraged to participate in health care programs when they see their own local government leaders spearheading the programs’ implementation. With the devolution of health and social service responsibilities to the LGUs, the resourcefulness and ingenuity of local leaders at finding ways to serve the needs of their constituents have been challenged and drawn out. DRN
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Staff Outreach Activities January-December 1997
November - December 1997
20 Years of Service through Research
[This listing continues from earlier issues of the DRN.]
Dr. Danilo C. Israel (Research Fellow) f
Went on Postdoctoral Research Fellowship from January 1-December 31. The fellowship at the University of British Columbia in Vancouver, Canada was sponsored by the International Development Research Centre (IDRC) of Canada through the Economy and Environment Program for Southeast Asia (EEPSEA).
f
Participated in the following fora: l 8th Biannual Workshop on Economy
and Environment in Southeast Asia, Singapore, May 13-15; l British Columbia 21st Annual Mine
Reclamation Symposium and the 22nd Annual Canadian Land Reclamation Association Meeting held in Cranbrook, British Columbia, Canada, September 22-25. DRN
The Rooftop of the NEDA Sa Makati Building was the site of the event. Keeping in mind this year’s rather ambitious theme, “Peace and Prosperity to the Philippines and the World,” the PIDS staff started with an ecumenical service and then went on with a very creative program churned out by this year’s Christmas party committee members who started the ball rolling with a wildly-cheered dance number showcasing ethnic Filipino dances.
Christmas at PIDS has always been a season of giving and sharing. Yuletide 1997 is no exception as the
Christmas at PIDS
W
hile half of Metro Manila was stuck in heavy traffic on the night of December 19 scurrying for last minute Christmas shopping, all of PIDS were having a fun time having its Christmas party. Austere as it may have been (there were no television sets, washing machines or electric fans raffled off), it was nevertheless celebrated with enthusiasm and goodnatured ribbing, manifesting the strong camaraderie among the PIDS family.
annual Mr. & Ms. PIDS polls. Easily the most contested award which divided the staff into “factions” and with one candidate even having his own home page, it elicited the participation of everyone and brought a fresh addition to the annual celebration.
Special awards (“hearthrob,” resident Scrooge, “most enterprising,” etc.) were given to unsuspecting staffmembers, along with the Best Room Decoration prize. The highlight of the program, however, was the announcement of the results of the first
Institute's rank-and-file employees received baskets of groceries donated by generous "friends of PIDS" and the senior PIDS management and research staff.
Finally, the affair was capped with Kris Kringle revelations and dancing that lasted until midnight, with the distinguished PIDS President showing everyone that he knew a step or two of ballroom dancing. So who says economists are Some members of the Christmas party committee do a Muslim square?
dance.
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DEVELOPMENT RESEARCH NEWS
Communities Help Themselves ... from Page 5 Project (MBBP), a health financing scheme supported by the LGU. Fourth , there is a need to involve the private sector but in a way that will make the project remain affordable to the members and conversely, that will make it feasible for the private corporation to earn. And last, it was observed that a mechanism must be instituted to subsidize the members who are poorer than the rest. To avoid criticisms from the members and guard against abuse, the scheme managers must get the support of the community and get guidance from experts in this field.
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mum of 20 households. This poses a problem in that the scheme would be difficult to sustain because of the little pooled amount. b Networking communitybased health financing schemes (HFCs) with the existing health system. Community-based HFS complements the efforts of government health services and program since they can reach a wider clientele. As such, linking them up with other health systems is a move worth giving top priority. This link-up may also be more cost ef-
November - December 1997
Conclusion “Health is Wealth” is an adage that carries a double meaning for residents of poor communities like those in Region XI. To them, good health requires a certain amount of wealth to maintain – something that they do not have. But what they have in abundance is a strong sense of volunteerism, cooperation and selfhelp attitudes from which they drew the initiative to put up their own health financing schemes. As seen in the earlier examples, however limited and small the coverage and benefits are, the
Policy recommendations After all the data have been culled, responses made and observations Community health care financing in Mindanao revisited. Panelists in the roundtable discussion innoted, should more of such cluded: (foreground, l-r) Dr. Salvador Estrera (DOH-RHO XI), Ms. Linda Laureta (PHIC), Dr. Alejandro Herrin schemes then be estab- (UPSE) and Ms. Maylene Beltran (DOH); (background, l-r) Mayor Justina Yu, Ms. Asuncion Chin (formerly lished? If so, what contribu- with IPHC-DMSF), Bgy. Captain Danny Darroca and PIDS Acting VP Mr. Mario Feranil. tory actions and decisions may the government and other external groups focus on to make fective compared to providing health schemes had a positive effect on the recipients and, to a certain extent, ima certain community’s social and eco- services under the present set-up. proved their health status and ennomic conditions more conducive to b Capacity-building require- hanced their health practices and bethe development of community health m e nts. Technical support given by havior. Indeed, the common observafinancing schemes? NGOs to these schemes should be in- tion of the recipients is that the health The following are some recom- tegrated in the development plans of financing schemes boosted their conlocal government units. The case study fidence in seeking immediate medical mendations: recommended that support given by treatment for their ailments. However, b Pro m o tion of efficient/ eco- external groups should go beyond the failure of some schemes to last long nomic scale size community-based seed fund requirements and focus on should prompt the government to eshealth financing scheme. It was noted management aspects, i.e., pricing of tablish policies that will nurture and that most of the schemes were limited services, and facilities management, help institutionalize community-based health financing schemes. DRN in membership, usually having a mini- among others.
DEVELOPMENT RESEARCH NEWS
Editor's Notes ...
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Linking Health Care Schemes ...
from Page 1
from Page 6
in Davao City. The updates as reported by the former director of IPHC serve as eye-openers to our policymakers in the effort to institutionalize health care financing schemes.
considering since their involvement would help attract other residents to join the program. Meanwhile, Chin also pointed out that the more effective means to convince the residents to participate and sustain their commitment is by improving the quality of health care and making them more accessible to the people. Thus, improving the skills of barangay health workers was as important as upgrading the facilities of the clinics and barangay health stations. In a broader perspective, the capability-building component must no longer focus solely on service provision but must also include training on operations management.
The four succeeding articles are culled from the roundtable discussion that generated several insights that we hope will bolster the development of health care financing schemes in the country, especially in the remote municipalities in the countryside. In highlighting these updates in health care financing organizations at the grassroots level, we note that the people themselves—even though lacking in resources—are making the initiative to meet their health needs. Health care may not be tops in the priority list of survival for some of our people but slowly, more and more Filipinos are realizing that it is the key to a meaningful and productive living.
Finally, Laureta said that the areas of partnership that the NHI scheme and the communities can explore are certainly numerous. In fact, the PHIC is in the process of ironing out the rules regarding accreditation standards especially for health care providers.
DEVELOPMENT RESEARCH NEWS is a bi-monthly publication of the PHILIPPINE INSTITUTE FOR DEVELOPMENT STUDIES (PIDS). It highlights the findings and recommendations of PIDS research projects and important policy issues discussed during PIDS seminars. PIDS is a nonstock, nonprofit government research institution engaged in long-term, policy-oriented research. This publication is part of the Institute's program to disseminate information to promote the use of research findings. The views and opinions expressed here are those of the authors and do not necessarily reflect those of the Institute. Inquiries regarding any of the studies contained in this publication, or any of the PIDS papers, as well as suggestions or comments are welcome. Please address all correspondence and inquiries to: Research Information Staff Philippine Institute for Development Studies Room 304, NEDA sa Makati Building, 106 Amorsolo Street, Legaspi Village, 1229 Makati City, Philippines Telephone numbers 892-4059 and 893-5705 Telefax numbers (632) 893-9589 and 816-1091 E-mail address: publications@pidsnet.pids.gov.ph Re-entered as second class mail at the Makati Central Post Office on April 27, 1987. Annual subscription rates are: P150.00 for local subscribers; and US$20.00 for foreign subscribers. All rates are inclusive of mailing and handling costs. Prices may change without prior notice.
November - December 1997
With these developments, it is clear that establishing and beefing up the networking of health care service schemes is one effective means of realizing the goal of sustaining their continued operations and making sure that more people benefit from their services. DRN
Vol. XV No. 6
November - December 1997
Editorial Board Dr. Ponciano S. Intal, Jr. President Dr. Mario B. Lamberte Vice-President Ms. Jennifer P.T. Liguton Director for Research Information Mr. Mario C. Feranil Director for Project Services and Development Ms. Andrea S. Agcaoili Director for Operations and Finance Atty. Roque A. Sorioso Legal Consultant
Staff Jennifer P.T. Liguton Editor-in-Chief Barbara B. Fabian Issue Editor Corazon P. Desuasido, Genna J. Estrabon, Edwin S. Martin and Liza P. Sonico Contributing Editors Valentina V. Tolentino and Rossana P. Cleofas Exchange Delia S. Romero, Galicano A. Godes, Necita Z. Aquino, Lilet L. Lamayo and Federico D. Ulzame Circulation and Subscription Jane C. Alcantara Lay-out and Design