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Quality Assurance Program (QAP) Goal: To make DOH and LGUs active partners in providing quality health services

Key Strategies: 1. Certification/Recognition Program - CRP 2. Continuous Quality Improvement - CQI Sentrong Sigla Movement Goal: Quality Health Objectives: Better and more effective collaboration between DOH and LGUs DOH: as provider of technical and financial assistance packages for health care LGU: prime developers of health systems and direct implementers of health programs Sentrong Sigla Movement Pillars: quality assurance grants and technical assistance awards health promotion Phase I II III Period 1998-2000 2001-2004 2005-2010 Standards Input Process Outcome or Impact

Achievements of Sentrong Sigla SS - Certified as of end of 2003 53% of health centers 15% of district and provincial hospital 3% of BHSs Additional awards for several facilities Positive Outcome of Sentrong Sigla created a quality service-orientation among public health service providers promoted interest and participation of LGUs in raising quality health services generated additional support from LCEs for health; channeled local resources to fund supplies, basic, equipment of facilities Improved quality of services in general'changed attitudes of service providers; perceived increased utilization of services effective tool to maitain DOH leadership in health that would ultimately redound to health impact serveral health centers received CQI training; some established quality circles Valuable Lessons realization to the need for total systems quality standards that combine simple yet

basic input. process and output standards importance of careful selection of incentives the need for changin procedures to provide adequate time for crucial processes to take place and be internalized prior to the assessment

Quality Standard Lists for Health


The Department of Healths (DOH) Quality in Health (QIH) Program seeks to institutionalize Continuous Quality Improvement or CQI in health care in order to create health impact in terms of health promotion and diseases prevention and control. Sentrong Sigla Certification has been identified as one of the components and strategies of this program. The quality standards cover total systems quality for outpatient care and public health services graduated into three levels. This quality standards list (QSL) covers the basic certification level or Level 1. The next higher levels of specialty award and award for excellence, Levels 2 and 3 respectively, have their own standards lists. Aside from the QSL, other tools available for use of the health facility staff are the Supervisory Forms (SF) and the Facility Certification Form (FCF). PURPOSE: The Quality Standards List (QSL) is the over-all reference document for Sentrong Sigla certification of health facilities. It is a list of the basic standards and requirements that are necessary to ensure that a health facility is providing quality health services. The QSL concentrates on several key areas and programs and lists the minimum requirements for each. The QSL measures health facility performance relative to the availability of resources (input) as well as actual service delivery (process) and performance (output). The QSL may be used as a self-assessment tool by health facility managers and service providers to determine their potential to deliver quality health services. The results of such an exercise may be used by the local government in planning for health facility improvement and for resource mobilization. ORGANIZATION: The standards list is subdivided into four sections: Facility and Systems, Integrated Public Health Functions, Basic Curative Services Function and Regulatory Functions. Two of the sections, Facility and Systems and Integrated Public Health Functions, are further subdivided into sub-sections. The QSL is organized as follows: o Standard statements are preceded by an identifying notation. o Each standard statement is followed by a verification step or steps. The verification step/s is/are the means by which the standard is best evaluated. There are verification statements that have been incorporated in the FCF and a corresponding notation is placed

in the right lower corner. This notation refers to the FCF section and item number where this is cited. When the verification step requires the use of an additional tool or reference material, the said material has been incorporated as an appendix unless otherwise stated. The Appendices have been arranged in the order by which they have been cited in the QSL but in not included in this list. The example below illustrates the organization of each section of the QSL.

Strategic Framework & Plan for Phase II-2003-2007


In 1998, the Department of Health (DOH) formulated a Quality Assurance Program (QAP) with assistance from USAID through a project managed by the Management Sciences for Health (MSH). The goal was to make DOH and LGUs active partners in providing quality health services. The objectives were to institutionalize QAP through capability building, developing a cadre of quality experts, advocates and practitioners; to establish mechanisms to coordinate, support and monitor QA efforts, develop and implement an effective IEC and advocacy campaign, and make clients active partners in health. The program had 2 main strategies: certification/ recognition of rural health units, health centers and barangay health stations that have met established criteria; and capability building to internalize continuous quality improvement (CQI) of health services in these facilities. The program aimed for certification of 80% of health centers based on minimum standards for readiness to provide services, ie. input standards; and for 80% institutionalization of CQI programs at the LGUs in the provinces and cities.

Guiding Principles for Sentrong Sigla

To ensure that Sentrong Sigla remains focused on its quality goals and objectives, the following guiding principles are hereby adopted: Recognition for achieving good quality shall be the main incentive in SS certification. Advocacy and social mobilization activities should be used to enhance the value of prestige and recognition. Other incentives shall not be overemphasized and should only be secondary to recognition. Quality improvement is an unending process. SS certification should promote the continuing drive for ever-improving quality by providing multi-tiered and progressively higher quality standards. SS certification shall focus on core public health programs that have been proven to be most cost-beneficial to the people such as child health, maternal care and family planning, prevention and control of infectious diseases, and promotion of healthy lifestyle. Public health programs are best integrated, synergized and synchronized to achieve maximum health impact. Quality improvement is a partnership that empowers all stakeholders. In SS, communication between the DOH and the health facilities to be certified shall be open and shall be based on mutual trust and transparency. All quality standards and the methods by which these shall be assessed shall be openly shared and discussed to ensure clear understanding and strong commitment by all concerned. In the same spirit, roles, responsibilities and contributions shall promote appropriate counterpart and reciprocity. To ensure even distribution of quality health services, DOH assistance shall be purposive, targeting to achieve quality improvement in health facilities that have been identified using carefully selected health priorities and health needs. These should include health facilities in farflung and underserved areas, in congested urban centers or in marginalized communities. To ensure objectivity and broad, varying perspectives, SS assessment shall involve partners in health from non-DOH units such as other government and non-government agencies. They shall be encouraged to actively advocate for and give support to SS.

Definition of Terms
Definition of Terms The following terms as defined in the larger QIH Program are hereby included in SS, as

follows: 1. Quality degree of excellence or desirability of a product, usually measured in relation to conformity with a given standard. 2. Quality Control (QC) set of functions designed to insure quality in manufactured products by relying on periodic inspection of finished products, analysis of results of inspection to determine causes of defects and systematic removal of such causes. 3. Quality Assurance (QA) set of functions designed to insure quality in manufactured products by preventive or pre-emptive removal of potential sources of 4. defects through constant improvement of production technology, engineering design, materials, processes, equipment and workmanship. 5. Quality Management (QM) the organization-wide pursuit of quality

6. Quality Improvement (QI) the broad all-encompassing generic term for processes involved in the continuing pursuit to improve quality. 7. Performance Improvement a type of QI focused on the systematic and continuing improvement of organizational performance in order to achieve total quality 8. Total Quality Management (TQM) the pursuit of quality that involves not just the production organization but also its clients and customers, suppliers and sub-contractors, competitors and oversight agencies in the market, and all other stakeholders in the community. 9. Total Quality - the ultimate goal in quality improvement which involves doing the right thing right the first time and all the time while meeting the needs of internal and external stakeholders and customers. 10. 1998 Quality Assurance Program refers to DOH quality program formulated in 1998 that is focused on improving the DOH-LGU partnership to provide quality health services. The QAP started the certification and recognition strategy for improving health services in health centers, rural health units and barangay health stations. The Sentrong Sigla Movement replaced the QAP. 11. Sentrong Sigla Movement the term used in 1999 to refer to the 1998 QAP. The SSM is essentially the same as the 1998 QAP, with some minor additions like the inclusion of local hospitals in the certification and the listing of 4 pillars to support the process. This term was also used to refer to other quality-related concepts such as the quality improvement philosophy, the multi-sector nature of CQI, and the value changes in CQI. The Philippine QIH Program replaced the SSM. 12. QIH Program refers to the Philippine Quality in Health Program, the current quality improvement program (AO 17-B s. 2003) that replaced the QAP and the SSM.

The QIH has expanded the scope of the quality initiatives to involve the entire health sector, not only the DOH and the LGU services, and now includes licensing and other efforts such as accreditation by PHIC or other professional societies in its strategies. 13. Sentrong Sigla Certification refers to the strategy of assessing health facilities against established health services criteria and recognizing those that successfully meet the criteria. The certification process is expected to lead to changes in the health facility when they strive to meet the criteria. 14. SS Quality Standards List (QSL) the list of basic SS criteria to be met by health facilities. In SS Phase II, the QSL for Level 1 certification includes input, process and output criteria. 15. SS Facility Certification Form (FCF) the form that is used in the formal assessment of health facilities. The FCF contains standards that will be measured by the SS Assessor and the method by which these will be measured. It also works as the scoring sheet. 16. Supervisory Form (SF) the form used by the health facility supervisor (the nurse or the physician) in assessing the capability of his/her health staff, usually the midwives. This contains the standards that are measured mostly through direct observation of provider-client interactions and in depth review and analysis of records. 17. Inputs the resources needed to provide care or services such as staff, equipment and supplies 18. Processes a series of activities or tasks, for instance, admission processes or patient care management 19. Outcomes the results of the processes

Goals
As one of the accreditation strategies in the QIH Program, Sentrong Sigla Certification has the same long term and intermediate goals as the Philippine QIH Program: Long-term goal: To institutionalize within the health sector the leadership, processes, knowledge, attitudes, skills and organizations that will generate Continuous Quality Improvement in health care thus creating health impact in terms of health promotion and disease prevention and control. This goal is a process and systems goal, fully recognizing that the quest for better quality health care and services is a continuing or unending process. This is also an expanded goal, aimed to cover the entire health sector, not only the

public health or government sections of the sector. Intermediate (5-year) goal (2003-2007): To improve the quality of health care in outpatient health facilities, hospitals and the public health services in the communities. In specific terms, this goal will be carried out by establishing specific quality criteria and by targeting (a) to raise the average quality of outpatient care, hospital care and community/ public health care; and (b) to reduce the variation around the average quality of care among these different categories of providers and services. Thus, the specific goal of Sentrong Sigla Certification is to improve the quality of outpatient health care (public and private) and of public health services in communities. For 2003 2007, SS will put emphasis on improving the quality of services in local government health facilities and of public health services in communities.

As one of the accreditation strategies in the QIH Program, Sentrong Sigla Certification has the same long term and intermediate goals as the Philippine QIH Program: Long-term goal: To institutionalize within the health sector the leadership, processes, knowledge, attitudes, skills and organizations that will generate Continuous Quality Improvement in health care thus creating health impact in terms of health promotion and disease prevention and control. This goal is a process and systems goal, fully recognizing that the quest for better quality health care and services is a continuing or unending process. This is also an expanded goal, aimed to cover the entire health sector, not only the public health or government sections of the sector. Intermediate (5-year) goal (2003-2007): To improve the quality of health care in outpatient health facilities, hospitals and the public health services in the communities. In specific terms, this goal will be carried out by establishing specific quality criteria and by targeting (a) to raise the average quality of out-patient care, hospital care and community/ public health care; and (b) to reduce the variation around the average quality of care among these different categories of providers and services. Thus, the specific goal of Sentrong Sigla Certification is to improve the quality of outpatient health care (public and private) and of public health services in communities. For 2003 2007, SS will put emphasis on improving the quality of services in local government health facilities and of public health services in communities.

Objectives
Sentrong Sigla Certification has the following specific objectives for 2003-2007, Phase II: By 2007, 1. To establish an efficient system of providing technical and other forms of assistance to outpatient health facilities, of assessing health services against established criteria, and of monitoring key indicators in the SS certification process 2. To progressively raise the average quality of public health services through recognition of successful attainment of quality standards: At least 50% of health centers in the country successfully meet the revised SS Phase II Basic Certification (Level 1) standards At least 20% of Level 1 certified health centers successfully meet SS Phase II Specialty Award (Level 2) standards for all four core public health programs (child care, maternal care/ family planning, prevention and control of infectious diseases, and promotion of healthy lifestyle) 3. To raise public awareness of, public support and demand for, and client participation in SS certification of their health services and facilities

Overall Certification Process


Objectives for 2003 2007, Phase II Sentrong Sigla Certification has the following specific objectives for 2003-2007, Phase II: By 2007, 1. To establish an efficient system of providing technical and other forms of assistance to outpatient health facilities, of assessing health services against established criteria, and of monitoring key indicators in the SS certification process 2. To progressively raise the average quality of public health services through recognition of successful attainment of quality standards: At least 50% of health centers in the country successfully meet the revised SS Phase II Basic Certification (Level 1) standards At least 20% of Level 1 certified health centers successfully meet SS Phase II Specialty Award (Level 2) standards for all four core public health programs (child care, maternal care/ family planning, prevention and control of infectious diseases, and promotion of healthy lifestyle) 3. To raise public awareness of, public support and demand for, and client participation in SS certification of their health services and facilities Overall Certification Process

The quality standards cover total systems quality for outpatient care and public health services graduated according to the following levels: Level Category Description Minimum input, process and output standards for integrated Level Basic public health services for 4 core programs, facility systems, 1 Certification regulatory functions and basic curative services Second level quality standards for selected public health Level Specialty programs (includes other health programs in addition to 2 Award Level 1 core programs) and facility systems Highest level quality standards for maintaining level 2 Level Award of standards for the 4 core public health programs and level 2 3 Excellence facility systems for at least 3 consecutive years All local health centers and rural health units are qualified to apply for Level 1 certification. Only those that passed Level 1 can go to Level 2; only those that passed Level 2 can proceed to Level 3. The certification process starts with participatory self-assessment at the local health facility level, assisted by the DOH Representative to the area. Then, for a period of about 3-6 months, depending on the deficiencies noted, the local health facility will have to improve its systems and services to meet the quality standards for the appropriate level. DOH Representatives and other regional technical staff shall assist the LGU in this transformation process, providing appropriate technical packages and other assistance as needed. Multi-sector Regional SS Assessment Teams that have been trained and certified as assessors shall conduct formal assessments using the appropriate Facility Certification Form. These teams will then recommend the certification of health facilities that successfully meet the standards criteria. Table 1 and Figure 1 summarize the major steps in the SS Certification process. Table 1: Major Steps for SS Certification Step 1: Orientation and invitation Step 2: Self-assessment by LGU Step 3: Provision of technical assistance Step 4: Formal assessment for Level 1, Basic Certification Step 5: Maintenance of Level 1; working for Level 2 certification Step 6. Formal assessment for Level 2 certification Step 7. Maintenance of Levels 1 and 2; working for Level 3 certification Step 8. Formal assessment for Level 3 certification Step 9. Maintenance of Levels 1, 2 and 3 certification The above strategy is designed to promote the continuing progression of health facilities towards higher quality levels. The pace of progress towards higher levels depends on the motivation of the health facilities. However, should health facilities not actively apply for certification into the next higher levels after 2 years, renewal

of their SS certification status would be validated by Regional Assessors every two years. The following is the recognition scheme: Level Recognition Level 1 SS seal, individual recognition Basic SS Certificate Level 2 Specialty banner, individual recognition, others Specialty Award Level 3 SS trophy, individual recognition, media exposure, Award for others Excellence Levels 1 and 2 recognition shall be conferred by the DOH through its CHDs. Recognition for Level 3 Award of Excellence shall be given at the national level. Matching grants shall be a mechanism to provide assistance to LGUs to achieve Basic SS Certification and to continue to attain higher levels of quality. Regionspecific procedures to assess needs and motivation shall guide prioritization of such grants. Facilities that did not progress into higher level certification after 2 years, but maintained their current certification status based on Regional validation, shall be given stickers confirming the renewal of the validity of their SS status. Validation shall be done every two years. There shall be no other incentives for mere renewal of SS status. Grants for technical assistance towards attaining higher level quality, however, may still be granted by the respective CHDs based on thorough assessment of the needs and the commitment of the health facility.

Goals
As one of the accreditation strategies in the QIH Program, Sentrong Sigla Certification has the same long term and intermediate goals as the Philippine QIH Program: Long-term goal: To institutionalize within the health sector the leadership, processes, knowledge, attitudes, skills and organizations that will generate Continuous Quality Improvement in health care thus creating health impact in terms of health promotion and disease prevention and control. This goal is a process and systems goal, fully recognizing that the quest for better quality health care and services is a continuing or unending process. This is also an expanded goal, aimed to cover the entire health sector, not only the public health or government sections of the sector. Intermediate (5-year) goal (2003-2007): To improve the quality of health care in

outpatient health facilities, hospitals and the public health services in the communities. In specific terms, this goal will be carried out by establishing specific quality criteria and by targeting (a) to raise the average quality of outpatient care, hospital care and community/ public health care; and (b) to reduce the variation around the average quality of care among these different categories of providers and services. Thus, the specific goal of Sentrong Sigla Certification is to improve the quality of outpatient health care (public and private) and of public health services in communities. For 2003 2007, SS will put emphasis on improving the quality of services in local government health facilities and of public health services in communities.

As one of the accreditation strategies in the QIH Program, Sentrong Sigla Certification has the same long term and intermediate goals as the Philippine QIH Program: Long-term goal: To institutionalize within the health sector the leadership, processes, knowledge, attitudes, skills and organizations that will generate Continuous Quality Improvement in health care thus creating health impact in terms of health promotion and disease prevention and control. This goal is a process and systems goal, fully recognizing that the quest for better quality health care and services is a continuing or unending process. This is also an expanded goal, aimed to cover the entire health sector, not only the public health or government sections of the sector. Intermediate (5-year) goal (2003-2007): To improve the quality of health care in outpatient health facilities, hospitals and the public health services in the communities. In specific terms, this goal will be carried out by establishing specific quality criteria and by targeting (a) to raise the average quality of out-patient care, hospital care and community/ public health care; and (b) to reduce the variation around the average quality of care among these different categories of providers and services. Thus, the specific goal of Sentrong Sigla Certification is to improve the quality of outpatient health care (public and private) and of public health services in communities. For 2003 2007, SS will put emphasis on improving the quality of services in local government health facilities and of public health services in communities.

Monitoring, Research and Evaluation


The quality level of each health facility, including the deficiencies of those not yet SS certified, are monitored to detect the increasing average quality level and the needs for assistance. Regional activities and performance are also

monitored using the attached forms, Annex E. Research is used to develop improved quality standards, program components and training packages and to evaluate the SS achievements.

Organization and Functions


The National Sentrong Sigla Certification Committee (National SSC Committee) serves as the multi-sector body that oversees policy recommendation and coordinates the various activities of SS, (figure 1). This committee also assesses the performance of the various subcommittees and DOH units involved in the implementation of the strategy. The subcommittees of the National SSC Committee with their respective functions are as follows: Sub-Committee on Standards and Procedures 1. Develops and recommends standards and procedures for Sentrong Sigla certification, as well as basic messages to various stakeholders, through multisector consultation and pilot-testing and taking into consideration other quality initiatives and accreditation programs of other agencies in the country; 2. Develops and disseminates guidelines on SS implementation to DOH staff at all levels; 3. Coordinates training of various stakeholders on standards, procedures and basic messages 4. Performs other functions as relevant to the development and dissemination of standards and procedures in SS Sub-Committee on Technical Assistance and Monitoring Assists the DOH Regional Offices/CHDs in the following functions: 1. Dissemination of SS standards, procedures, guidelines and basic messages to the other members of the health sector such as the local government units (LGUs) and private practitioners, among others; 2. Development of training assistance packages, systems and tools that will facilitate the attainment of SS standards; 3. Coordination of various sectors involved in the SS quality assessment of health facilities; 4. Development of monitoring tools and performance indicators and analysis of the SS results of the database for all health facilities (certified and not yet certified); 5. Monitoring of the achievement of identified SS program indicators of performance; 6. Identification and coordination of grants and projects that will facilitate the SS certification of target health facilities and systems in the country; 7. Other functions necessary to assist the LGUs and other members of the

health sector in attaining SS quality standards. Sub-Committee on Advocacy and Awards 1. Designs and recommends revised, graduated incentives scheme that puts emphasis on excellence rather than monetary incentives; 2. Identifies and mobilizes funds and partners in order to deliver these incentives; 3. Develops projects to facilitate SS certification of target health facilities and systems and performs the necessary processes to get these projects approved and implemented efficiently; 4. Advocates for multi-sector participation in the SS program based on the basic messages developed by the Standards and Procedures Sub-Committee with emphasis on the quality improvement benefits to different sectors involved; 5. Performs other functions necessary to make the SS incentives focused on excellence and to sustain interest and participation in the certification strategy. Functions of the DOH Regional Offices/CHDs in SS certification In addition to the technical assistance functions mentioned under the SubCommittee on Technical Assistance and Monitoring, the DOH Regional Offices shall: 1. Organize Regional SS Assessment Teams and SS Technical Assistance Teams; 2. Advocate for SS certification within their respective regions; 3. Identify and mobilize resources and partners to help enhance the attractiveness of the SS incentives scheme without putting too much emphasis on monetary or material rewards; 4. Develop regional projects that will promote and facilitate SS certification and active partnerships; 5. Perform other functions as necessary to implement SS certification and quality improvement activities within the health sector. Figure 1: National Structure for Sentrong Sigla Certification National SS Certification Committee

The Bureau of Local Health and Development (BLHD) serves as the secretariat of the National SSC Committee and is the primary unit tasked to develop and implement Sentrong Sigla Certification. The National SS Committee links with the National QIH Committee through the BLHD, whose member also sits as resource person in the National QIH Committee. The PHIC is a member of the National SSC Committee. Its Quality Assurance Unit is developing the accreditation standards for hospital services that will be adopted by SS to certify hospital services. The Regional SSC Committee in each Region oversees the SS implementation at the regional levels. The Regional SSC Committee is served by a secretariat headed by the duly designated SS point person. Regional SS Technical Assistance Teams assist the LGUs to understand and meet the SS quality standards. The multi-sector Regional SS Assessment Teams conduct the assessment for Level 1 Basic Certification of health facilities within their respective areas. National Assessment Teams may join Regional Assessment Teams for Level 2 assessment when needed. National Assessment Teams conduct the assessment for Level 3 certification.

At the Regional level, Assessor Field Supervisors oversee 2-4 field teams composed of at least 3 assessors per field team.

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Home About Sentrong Sigla Certification Quality Standard LIsts for Health Strategic Framework and Plan for Phase II-2003-2007 Background Guiding Principles for Sentrong Sigla Definition of Terms Goals Objective Overall Certification Process Procedure Advocacy, IEC and Social Mobilization Monitoring, Research and Evaluation Organization and Functions Financing Future Directions Commonly Asked Question Glossary