This was my talk for the Kaya Natin-Ateneo School of Government Young Leaders for Health Conference. The participants are medical school students from all over the country. The goal of the 3 day conference is to encourage them to craft a public health initiative for their selected community for a competitive grant at the end of the 3rd day. My session goal was to frame public health as an instrument in national development. But at the same time, I wanted them to see their initiatives as a sound public health development project.

1. Health as an Instrument
Towards National Development
Youth Leaders for Health Conference
October 24-26, 2013
Antipolo City
The Office of
Senator TG
Guingona

2. Session Goal
Trends in health to anchor your initiatives.
-> serves as an entry point in developing an agenda
Health and poverty are intimately connected.
-> health a factor in poverty alleviation
Health is a complex issue which require
leadership and technical solutions.
-> a perspective that enable us to develop strategies that work.
Some things I have learned that work.
-> pick up a few practices & strategies for your initiative
You need to see your work of promoting health as part of
National Development

3. Our Public Health Context
Devolution of the Philippine Healthcare System in 1991
Fragmentation of Health Services
Inequities in Health
Outcomes
Rich
Urban
Life expectancy
>80 yrs.
< 60 yrs.
Maternal
Mortality Ration
<15
>150
Skilled Birth
Attendant
Health Responsibility
in Devolved System
Poor Rural
92.4%
25.1%
Mayor
Key in
Improving the
System

4. how do we improve
health?
Government Policy & Spending
Systems Development
People Participation

5. Out-of-Pocket Spending
India
Philippines
Malaysia
World
Thailand
Source: World Bank

6. Public Health Expenditure
Source: World Bank

7. What are the current health
needs of the country?

8. unhealthy statistics
Philippines
2001 2008
Pneumonia
Incidence
2010
652,000
Cases
Expected
to be top
10 in the
world
780,000
Cases
18% of under 5 years old
deaths due to pneumonia
Top 2 leading cause of
death over 60 yrs. old

9. unhealthy Statistics
Senior Statistics Survey
79 Barangays, 9,000 Seniors
Hypertension
DOH & DSWD
estimates
that senior population
will be at 10% by
2030
Diabetic
25%
15% to 20%
Hypertensive
range suffer from
40%
Type 1 & 2
Pre-hypertensive
diabetes
WHO & NSO
estimates
6.1% of population
will be diabetic by
Senior health needs are inevitable
2030

10. healthy Statistics
Philippines
MDG Goal
55 deaths/
100,000
Thailand
Malaysia
99 deaths
64 deaths
29 deaths
per 100,000
per 100,000
per 100,000
live births in live births in live births in
2010
2010
2010
down from
down from
down from
170/100,000 54/100,000 in 53/100,000 in
in 1990’s
1990’s
1990’s
Singapore
3 deaths
per 100,000
live births in
2010
down from
6/100,000 in
1990’s
live births
*source: CIA world factbook
unfpa.org
41.7% 18.5% 45.2% 50.0%

11. Top 3 PhilHealth Claims
1st Quarter of 2011
Pneumonia 79,631
Chronic Renal Failure 68,739
Single Normal Spontaneous
Delivery 55,519
Philhealth reduces out-of-pocket expenses at the same
time it can serve as an instrument for PARTICIPATION.

12. PhilHealth Utilization
In District 3, Quezon City, only 17
people used PhilHealth out of the
600 we enrolled.
Participation leads to learning which
changes behavior and improves the
demand for health. This is key in
addressing the complexity.
Philhealth reduces out-of-pocket expenses at the same
time it can serve as an instrument for PARTICIPATION.

13. Preview of Health Complexity
Disease & Health Burden of the Poor
High Income/
Urban Areas
Life expectancy at
birth
Infant Mortality
Rate
Maternal
Mortality Ratio
Dr. Jaime Galvez-Tan, Former DOH Secretary
Low Income/
Rural Areas
>80
<60
<10
>24
<15
>150

14. Health Complexity
Vaccinations#
With%no%vaccinations%
Percentage%of%children%who%received%vaccines%
47.9%
46.9%
42.7%
34.6%
19.1%
14.4%
1.8%
No#education#
Elementary#
High#School#
2008 NDHS* Report on Vaccinations of Children and their Mother’s Educational Attainment
2.3%
College#

15. Health Complexity
Contraceptive%Use%%
Use%of%any%Contraceptive%method%
Not%currently%using%any%
81.5%
54.7%
45.3%
53.2%
46.8%
53.1%
46.9%
18.5%
No%education%%
Elementary%%
High%school%%
College%%
2008 NDHS Report on Use of Contraception by Women of Reproduction Age and their Educational Status

16. Health Complexity
Antenatal Care Trends
Percentage of women whose last live birth was protected against
neonatal tetanus
Percentage of women with antenatal care from a health professional
79.5
74.5
94.1
97
High school
College
68.9
34.2
80.4
44
No Education
Elementary
2008 NDHS Preliminary Report on Maternal Care Indicators and their Relationship to Mothers’ Education

17. Health Complexity
Knowledge#of#AIDS#
Percentage%of%women%who%have%heard%of%AIDS%
84.1%
99.4%
96%
40.3%
No#education#
Elementary#
High#School#
College#
2008 NDHS Report on Knowledge of Women of Reproductive Age of AIDS and their Educational Status

18. Supply & Demand
STRENGTHEN
HEALTH
LEADERSHIP AND
GOVERNANCE
QUALITY AND
RESPONSIVE HEALTH
SERVICES
• Municipal Accountability
• Barangay Accountability
• Coaching, Mentoring and
Monitoring
HEALTH EMPOWERMENT
AND ENTITLEMENT
EDUCATION
Improved Health Indicators
ENHANCE
SUPPLY SIDE
• Human Resource
• Facilities
• Medicines
• Innovative Programs
DEMAND SIDE
INCREASE
• Health Seeking
Behavior
INCREASED UTILIZATION OF
RELEVANT HEALTH PROGRAMS
AND SERVICES
Where is leadership in
addressing this?

19. What have I learned?
We need to position our initiatives to create a
generative understanding of the complex
health issues in order to increase participation
and ownership.
!
We need to create engagement opportunities
that enable people to discover their roles in
the health development agenda and enable
them to see themselves fulfilled in
accomplishing these roles.
How have we done this?
The Office of
Senator TG
Guingona
Let me tell you some of my stories that engage people.

20. San Isidro Story
Learning BHW Development
Building Accountability from the
Ground-up

21. From: Political Appointees
“NOON, inuutos ko ang
pagsunod sa programang
galing sa itaas. Maraming
intriga at reklamo,
magulo ang talakayan at
natatapos ang meeting ng
walang saysay.”
LUISA L. IMBAG
President of BHW & KaLiPi
BL Advocate

22. To: Program Advocates
“NGAYON, ang meeting lahat ay
nagmumungkahi at naka-focus na sa
programa. Ang mga issues related na sa
program. Masaya ang mga BHW kasi may
solusyon na.”
“Nakagagawa na
kami ng plano para sa susunod na
activities. Ipinaglalaban
namin ang aming ginagawa.
MAY BOSES NA KAMI”
LUISA L. IMBAG
President of BHW & KaLiPi
BL Advocate

23. San Isidro Story
Maternal & Infant Mortality
went to zero for a long time
Household income increased
Tax revenue increased
What happened?

24. San Isidro Story
When we strengthen frontline
leaders, we deepen health ownership
and improve our program output.
What have I learned?

25. KN Senior
Wellness Program
Leadership in health is
about empowerment.
!
Ang ibig sabihin nito, ay
ang pagbibigay ng halaga
sa tao sa pagtugon sa
sariling kalusugan.
Kalusugan ni lolo at lola

26. Engaging the Barangay
Leaders and Seniors

27. KN Senior Wellness
80-90% coverage of seniors in
79 Barangays, about 9,000
seniors engaged
Regular checkups to 4,500
seniors
Lifestyle change in our seniors
What happened?

28. KN Senior Wellness
We need to set regular, repetitive
engagements to shift the existing
mental models. These are actionreflection venues that create
transformative learning.
These venues deepen ownership
and enable personal accountability.
What have I learned?

29. Quezon City Story
Health Leaders for Mothers
a maternal health development initiative
The RH Dialogue
MMR was zero for 2012 in District 3
In facility birthing and Pre-natal checkup went up
What happened?

30. Quezon City Story
Health Leaders for Mothers
a maternal health development initiative
We need to go beyond the
debate and establish areas of
deeper understanding.
What have I learned?

31. What I do now.
Health Leadership &
Governance Program
Engaging DOH Regions, Mayors, & Governors
towards Primary Health Development
Bridging Leadership driven Public Health
Development to address inequities
WHO 6 building blocks to improve Health Systems

32. Health Leadership &
Governance Program
What have I learned?
We need to
strategically engage
government to create
deeper change.
Engaging DOH Regions, Mayors, & Governors
towards Primary Health Development
Bridging Leadership driven Public Health
Development to address inequities
WHO 6 building blocks to improve Health Systems

33. Finding a new kind
of leadership
DOH Regional Director Dr. Abdullah
"Okang" Dumama Jr. Keynotes the
leadership workshop of DOH Region 11.
Region 11 DOH CHD Leadership
Workshop
"We cannot just be maintainers.
HLMP* for the poor means we
exercise our different ways to
lead to help the poor. Sometimes
leaders tayo, sometimes followers
but we need to create new
arrangements to improve health."
*HLMP - Health Leadership & Management for the Poor
Health Leadership & Governance Program