Strategic Innovations in Operating Devolved Government Hospitals
Given a choice, most people would prefer to go to private hospitals rather than government hospitals because, more often than not, government hospitals lack sufficient facilities, equipment and skilled personnel.
In Misamis Oriental, the government hospitals lack beds and suffer from occupancy rates that exceeded 85%. These hospitals also have problems in communicating and transporting inter-facility patient referrals, which often result in delays and inability of the receiving facility to accept the referral. And since specialist and subspecialist services are often only offered in hospitals in the major cities such as Cagayan de Oro City, Butuan City and Iligan City, patients in the municipalities often have no or limited access to these crucial services.
In most of the government-run hospitals in the province, the most pressing problem is the inadequacy of supplies and equipment. The government procurement system is cumbersome and takes about three months from the date of request for supplies to the date of delivery. PhilHealth reimbursements which could be used to buy medical supplies are often delayed by six months or more. As a result, the Revolving Drug Fund becomes depleted and cannot cope with demand. And because of poor budget monitoring for medical supplies, the hospitals are often unaware about available funds.
To address these problems, the provincial LGU created a Technical Working Group (TWG) to conduct assessment and consultative meetings and come up with correct interventions to the different challenges faced by each hospital. It also gave its approval to the Provincial Health Office (PHO) to make a Provincial Investment Plan for Health (PIPH) with technical assistance from the Department of Health.
Subsequently, the PHO called for a planning session which was participated in by the Chiefs of Hospitals, Municipal Health Officers, DOH representatives, Municipal Planning Officers, Municipal Budget Officers and NGOs. These planning sessions led to the crafting of the Municipal Investment Plan for Health (MIPH) which is the basic document for the PIPH. This document was then presented to the Joint Appraisal Committee composed of different funding agencies during the assessment of provincial plans on September 11, 2009. The document received a grade of A which meant that financial support from the funding agencies would be provided to the provincial government for its health programs, projects and activities (PPAs).
Subsequently, the Provincial LGU introduced innovative strategic reforms to address the identified gaps and improve government hospital services. Among the identified strategies included outsourcing additional funds for facility development, establishing= network connectivity to improve referrals and communications, tapping medical societies, introducing a consignment scheme and a pharmacy enterprise and establishing logical workflows.
With the funding support secured, the Provincial Health Office-Hospital Operations consulted and partnered with other stakeholders of MisOrPH-Gingoog. Among those consulted were NGOs, government agencies, media and civic organizations who pledged their support to the program. The support was manifested in the sharing of resources among the partner agencies.
The Mobile Surgery Services Project, which began in January 2010, provides surgical manpower to the provincial-managed hospitals. The LGU has entered into a MOA with the Mindanao Consortium on Surgical Residency Training Program, to be able to tap the expertise of 31 multi-specialist staff from various hospitals based in Cagayan de Oro City. The agreement includes the deployment of complete operating room staff if these are not available in the concerned hospital. It also allowed the referral of difficult major surgery cases to any of the partner private hospitals with no extra surgical fees charged against the patient.
The LGU’s partnership with SMART Telecom led to the internet connectivity between the hospitals in Misamis Oriental and the medical specialists based in Cagayan de Oro City. This connectivity enabled online medical consultations, pre-operation screening of surgical patients as well as post-operation monitoring and the timely submission of medical reports. With its Misamis Oriental Pharmacy Enterprise (MOPE), the provincial government improved the physical and financial accessibility of essential drugs and medicines commonly dispensed to the public. This program employed a consignment scheme under a MOA with interested medical companies offering the lowest possible prices. This program addressed the problem of delayed procurement by the General Services Office.
Meanwhile, under the Laboratory tie-up scheme, the partner company provides the expensive medical machinery and takes care of its maintenance. This arrangement ensures the uninterrupted and continuous delivery of laboratory services. Lastly, infrastructure development financing is provided by DOH through its facility development bureau.
These innovations substantially addressed the identified gaps and resulted in the acquisition of better hospital facilities and motivated hospital personnel to offer better services. Medical indicators show that with the improved delivery of hospital services and facilities, more people from Misamis Oriental are now patronizing the government-managed hospitals.