4 PHFDP Zds Main97

Provincial Health Facility Development Plan
2008-2015
Chapter INTRODUCTION 1
1.1 Background/Rationale Health facilities are very important institutions for the economic and social wellbeing of society. Their curative and rehabilitative functions and a share of preventive mission as well, enable them to restore individuals to being productive members of society and fully enjoy the benefits that can be derived from it. The success of health facilities is therefore essential to attaining health sector reforms as they are integral part of healthcare delivery system in the country. This success is highly dependent on the availability of health facilities that are adequately equipped and supplied with medicines, and providing quality specialized services that are readily available and reasonably affordable. Since the hospital system is composed of government and private hospital sectors, with the latter generally perceived as superior in quality aspects, at par with government health facilities on convenience and location, but not as good on cost aspects, the interface between them needs further definition and their collaboration strengthened. Thus, private health facilities got significantly higher satisfaction or appreciation ratings than government. On the whole, LGU-owned health facilities are characterized as: poorly equipped, poorly staffed, and congested in the context of a very inadequate hospital networking and patient referral system with heavy reliance of direct national and local government subsidies, and uncoordinated implementation of public health programs in hospitals. Thus, past and current reform efforts are focused on developing and upgrading systems among government hospitals to make them more responsive to their clients needs and expectations. At the macro level, reforms are focused on addressing the disparity between public and private health facility performance as well as rural-urban inequities through the rational upgrading of critical capabilities of selected LGU and DOH hospitals, expanding hospital financing mechanisms, restructuring LGU hospitals into a corporate set-up, integrating public health programs into hospital services, and developing and/or improving hospital management systems, among other reform measures. 1.2 Legal Bases and Mandates
Zamboanga del Sur Province
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The Philippine Constitution under Article II, Section 15 thereof provides that the State protect and promote the right of health of the people and instill health consciousness among them. In promoting peoples health, government must operate health facilities primarily for curative and rehabilitative treatment and secondarily for preventive care, as privately owned hospitals cannot alone provide the much needed medical services and facilities in terms of access by the poor, thereby filling a void in peoples health needs, as well as, increasing accessibility to hospital care and services. Thus, addressing the needs of government hospitals in terms of its facilities, equipment and human resources are current imperatives of health sector reforms. 1.2.1 The Health Sector Reform Agenda
The Department of Health (DOH) has begun implementing the health reforms under its Health Sector Reform Agenda (HSRA) in selected cities and provinces in the country. The HSRA is the framework of the major strategies, organization and policy changes, and public investments to improve the countrys hospital systems, public health programs, local health systems, health regulatory systems and health financing systems. Considering that the overall reform process which covers a comprehensive agenda such as the HSRA takes some time to be fully implemented at a national scale, the DOH set up so-called convergence sites. The convergence sites were chosen based on the strong interest of local executives and their level of commitment on health, particularly in establishing dynamic health systems. Their number was defined by the capacity of the DOH and PhilHealth to provide enabling resources. The first batch of convergence sites are located in Pangasinan, Nueva Vizcaya, Bulacan, Pasay City, Capiz, Negros Oriental, South Cotabato, Misamis Occidental, Palawan, Southern Leyte, Agusan del Sur, Baguio City and Ifugao. In addition, twenty-one more convergence sites were identified as roll-out sites (second batch) including the province of Zamboanga del Sur. The reforms being implemented in convergence sites cover various aspects of the five key areas identified in the HSRA. For instance, the hospitals in the convergence sites are now implementing programs to improve management systems and quality of services. They are also pursuing measures to increase and retain revenues they generate to
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augment their budgets. 1.2.2 The National Objectives for Health (NOH)
The DOH has crafted the National Objectives for Health (NOH) for 20052010. The NOH, the road map for the health sector in the medium term, lays out the health status of the country, presents the health objectives in the near term and identifies the means by which to realize the objectives. 1.2.3 The Fourmula One (F1) for Health
The Fourmula One (F1) for Health is the guiding implementation framework for health sector reforms during the second half of this decade. Health interventions will be implemented as a consolidated package, backed by effective management infrastructure and financing arrangements. The entire health sector (public and private, national agencies, LGUs, the donor community and civil society) will be engaged in the implementation of health reforms. F1 for Health is intended to achieve three main goals: 1) better health outcomes, 2) more responsive health system, and 3) more equitable health care financing. The Five-Year Province-wide Investment Plan for Health of Zamboanga del Sur (PIPH-ZDS:2008-2012) focuses on addressing challenges in the health sector under the four reform areas of the Health Sector Reform Agenda (HSRA) being implemented through the F1 Framework. The Health Facilities Development Program is a among the major interventions under the Service Delivery Component, which include Facility Upgrading for Hospitals and Health Human Resource Provision and Capability Building, among other program/projects/activities (PPAs). 1.3 Current Issues on Public Hospital Management and Performance
Based on certain studies, the need to reform major components of the management practices of government hospitals appears necessary. These include practices on planning, budgeting for capital expenditures and for operating expenditures, purchasing, pricing, personnel policies and management, as well as control systems. Observations and comparisons made on management practices and performance of government and private hospitals point out that the system under which government hospitals are operating, that is subsidized by public funds, leads to inefficiencies. Such that under heavy resource constraints,
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government hospital managers must undergo intensive training on essential tools of management coupled with excellent leadership skills and appropriate attitude toward the job. Studies indicate that autonomy in hospital budgeting and funding may also prove advantageous in terms of economizing hospital operations given scarce financial resources. Under the present administrative structure, planning in local public hospitals must take into consideration the involvement of other key players outside the domain of the LGU by involving them and taking in their inputs and/or soliciting resources in order to augment limited budget. This could be in the form of joint venture undertaking between the government and the private sector. A critical factor though is the identification of private sector groups whose motivation is not solely for profit but also a strong interest and commitment to providing best medical care to the community. Results of studies on hospital management and performance suggest that public health facilities can be efficiently operated under private entity mode with government representation in the board as a minority owner. In this set-up, public hospitals can accordingly run efficiently under market conditions with full private incentive systems for its staff and employees and pricing. Under the scheme, the government share of the profits may fully cover the cost of about 25 percent of hospitals occupancy which can offset the cost for charity patients; thus, the LGU will not have to make allocations to cover the cost of rendering services to charity patients. 1.4 Needed Hospital Sector Reforms
To address many challenges that still remain for the health sector, the agenda for health sector reforms have been developed by the Department of Health (DOH). The Health Sector Reform Agenda (HSRA) describes the policies, public investments, and organizational changes needed to improve the way health care is delivered, regulated, and financed in the country. Specifically, the HSRA also seeks to provide fiscal autonomy to government hospitals. The conversion of government hospitals into corporate entities will promote fiscal autonomy by allowing them to collect socialized user fees. This move will take a great chunk off the DOH's and LGUs yearly appropriation for hospital operations. Thus, the government could use this savings to finance preventive public health programs. However, there is a need to enhance the capacities of government hospitals such as their diagnostic equipment, laboratory and medical staff to effectively exercise fiscal autonomy. Such investment must be cognizant of complimentary capacity provided by public-private networks. Most importantly, safety measures shall be carefully put into place to protect the interest of the indigents such as enrolling them in the National Health Insurance Program (NHIP).
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Chapter HEALTH SECTOR SITUATION IN ZAMBOANGA DEL SUR 2

2.1 The Province
Zamboanga del Sur province is located in the Zamboanga Peninsula Region in the western part of Mindanao. The province borders Zamboanga del Norte to the north, Zamboanga Sibugay to the west, Misamis Occidental to the northeast, and Lanao del Norte to the east. To the south is the Moro Gulf. Having common borders among the four (4) provinces previously mentioned, it is vulnerable to disease transmission from its neighbors. Though it is gifted with mountains, forestlands and rivers, it makes the province endemic to Malaria, Filaria, and Capillariasis. Its vast plains which are constantly flooded during the rainy season contribute to the further spread of schistosomiasis in Salug Valley; while, wet lands in some areas makes Avian Flu a threat to its inhabitants. Pagadian, the provinces capital city, is the center of commerce and the seat of provincial government and regional offices. It lies along the earthquake belt; thus, the citys coastal barangays and those of its neighboring municipalities are considered high-risk areas particularly on tsunamis and earthquake-related calamities and disasters. Political developments in February 2001 saw another major change in the territorial jurisdiction of Zamboanga del Sur. Its inhabitants voted to create a new province out of the Third Congressional District-named the Zamboanga Sibugay Province. Republic Act 8973 embodies the legal creation of the said province. The mother province is now left with 26 municipalities and one city with 681 barangays. After the sub-division of Zamboanga del Sur into two (2) provinces, two (2) Congressional Districts have been left. Congressional District I comprises 11 municipalities, one (1) city with 369 barangays while Congressional District II comprises 15 municipalities with 312 barangays. All in all, it has 26 municipalities and one (1) city with a total of 681 barangays. 2.2 Demographic and Socio-Economic Trends
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In the span of seven (7) years (2000-2007), the population of the province increased from 836,147 to 914,278 registering a growth rate of 1.28 percent which is lower than the previous growth rate (1995-2000) at 1.74 percent. At the said rate, the province is expected to double its population in year 2054. The male/female ratio in 1995 was 104:100 while in year 2000, it was 103:100. With a total land area of 4,477.36 km2, the provinces population density was 204 persons per sq.km. in 2007 from 187 persons per square kilometer in 2000. Rural-to-urban migration and rural-to-rural migration put so much pressure on providing basic social services like health care, shelter, water, sanitation and education. The congestion and pollution in urban areas are harmful to health. In remote communities, the peoples health is affected by difficult access to health services and presence of locally endemic diseases like malaria, filariasis and capillariasis. Agriculture, its major economic activity, exposes farmers to poisoning due to predominant use of pesticides and fertilizers; and even to Schistosomiasis. Fishing provides the second major source of livelihood. Piracy, blasting and natural forces make fisher folks prone to injuries, respiratory infections and drowning. Roads provide the basic transport infrastructure. A number of provincial roads are already improved (concreted) providing all weather access to key production centers and markets; hence, cases of injuries- and deaths due to vehicular accidents are also rising. However, key road sections still need to be upgraded, especially those servicing the network of basic health and medical facilities. The province is now directly linked to the trading hub of MindanaoDavao City via the newly-constructed PagadianCotabato National Highway. The Pagadian Domestic Airport is the provinces gateway to key growth centers in the country; while, the Pagadian Sea Port also serves as the provinces gateway to the BIMPEAGA. These trade routes are possible entry routes of smuggled poultry and poultry products from Avian Influenza (AI) infested Southeast Asian Countries. Ethnic diversity is considered to be one of the most important elements in understanding the province's development potentials as well as its problems. The province is shaped historically by various migration patterns with the Subanen people being the longest established group. This was followed by the Muslims and then by the Visayans. Other notable migrations came in later adding
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to accelerate development of the area. These are the Chavacano, Tagalog, and Muslims from neighboring provinces. The diversity in culture and mobile living tradition of Subanens influence the health-seeking behavior of the people. Families are closely knit and loyalties to clans are common features. This relationship, however, provides a strong support system especially during deaths, births, and major illnesses.
2.3
Vital Health Indicators
Despite considerable health sector reforms being introduced by government for the past 30 years including the devolution of health service delivery function to local government units, the overall health system in the Zamboanga del Sur continue to face low quality and inefficiency issues as well as insufficient progress on major health program areas and service delivery modalities. 2.3.1 Leading Causes of Mortality and Morbidity Injuries/wounds/accidents, the present leading cause of death in the province, has alarmingly threatened ZamboSurians over time, which is somehow reflective of the overall problem of injuries in the Philippines. The provinces Injury Mortality Rates considerably increased by 26.3 percent; from 28.75 per 100,000 in 1989 to 36.32 per 100,000 in 2006. One in five (5) deaths in the province is due to injuries. Intentional and motor vehicle crashes account for most of the recorded injuries. This is attributed to inadequate road signs, lack of knowledge on road safety, poor enforcement of laws like wearing of seatbelts and helmets, lack of sidewalks and pedestrian lanes, lack of street lights and driving under the influence of alcohol. Peace and order problem is also a factor that brought about high incidence of injuries and accidents. There is no existing injury surveillance system, hence documentation of fatal and non-fatal injury outcomes are obviously needed, as well as, identifying potential interventions for injury prevention. Collaboration with other government agencies like the Land Transportation Office (LTO) and the Department of Public Works & Highways (DPWH), Philippine National Police (PNP) needs to be done.
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Pneumonia remains in the list of the leading causes of morbidity and mortality in the province. It ranked third among the causes of mortality and fifth among the causes of morbidity in 2006. There is a decreasing trend of morbidity from pneumonia in the general population from 2001 to 2006. The mortality rate from pneumonia also decreased from 34.1 average deaths per 100,000 population from 2001-2005 to only 24.4 deaths per 100,000 in 2006. This reflects improvements in diagnostics and treatment. However, death rate from pneumonia among infants remained at the top of the leading causes though the trend is decreasing from the average of 2.41 per 1,000 live births for the period 2001-2005 down to 1.93 per 1,000 livebirths in 2006. Among children under five-years of age, pneumonia cases followed a downward trend since early 2000s, from the average of 2.41 per 100,000 under 5-years old children for the period 2001-2005 to 1.93 per 100,000 in 2006. Cancer is the fifth most frequent disease after pneumonia and diseases of the heart. Hereditary factors result in a higher susceptibility of an individual to acquire specific cancers, nutritional and environmental factors are also contributory factors to the development of cancers. One third of all cancers are curable if detected early and treated promptly, but patients seek consultation at the late stage of the disease because of lack of information on the warning signals of cancer. Due to high cost of health care, cancer patients could not avail of appropriate curative and preventive care. For other causes of morbidity in the province, such as Bronchitis, Acute Respiratory Infection, Influenza, Diarrhea and Tuberculosis came out to be high. These may be due to poor health seeking behavior of the constituents and distance from health facilities, and some households do not have access to safe potable water supply and toilet facilities. 2.3.2 Births In 2006, the crude birth rate (CBR) in the province was a low 19.27 births per 1000 population. A very high CBR of 35.7 was reported in the municipality of Kumalarang; while, the lowest CBR of 9.19 was reported in Midsalip.
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The total number of livebirths reported in 2006 was 17,101of which 8,842 or 52 percent were males and 8,259 or 48 percent were females. As in the previous years, there was a higher proportion of males born in 2006 compared to females, resulting in a birth-sex ratio of 107 baby boys born for every 100 girls born. The daily average of birth occurrence was 47, an addition of 1 baby to the provinces population every 30 minutes. In 2006, only 48.38 percent of deliveries were attended/handled by skilled health personnel. Most normal and other types of births were attended at home rather than in health facilities. About 7.53 percent of infants born were less than 2500grams which may be due to lack of prenatal care and poor nutritional status of the mother. This calls for more intensified advocacy on maternal health care, as well as, micronutrient supplementation to pregnant women. 2.3.3 Deaths The crude death rate (CDR) in the province deaths per 1000 population as compared population at national average. A relatively in the city of Pagadian; while, the lowest Dimataling. was also relatively low at 3.18 with 4 to 5 deaths per 1000 high CDR of 5.12 was reported CDR of 0.47 was reported in
There were 2,804 deaths reported in 2006. Daily death occurrence was one death every three hours. Of the number of deaths, 1,675 or 59.7 percent were males and 1,129 or 40.3 percent were females, a death-sex ratio of 148 males per 100 females dying in 2006. Provincial CBR in 2006 was still below the regional CBR. Likewise, the provincial CDR was also lower than the regions CDR during the same reference year. 2.3.4 Infant Under-Five Mortality Our country has a high probability of achieving the Millennium Development Goal (MDG) in reducing the rate of infant and under-five mortality. Record shows that Infant death had declined from 57% in 1990 to 24% in 2006 and hopefully to attain 19% in the year 2015. However in
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the province of Zamboanga del Sur, there was a significant decrease in infant death rate in 2003 from 5.68 per 1000 LB to 3.72 per 1000 LB in 2004. Likewise, and under five death rate from 9.90 per 1000 LB to 4.90 per 1000 LB. These may be due to under reporting. Cultural factors attributed to under reporting (e.g. Muslim Culture immediate burying of the dead). Lack of awareness on the importance and value of registration and lack of legislative support are also contributory factors to under reporting. Infant and under-five mortality differ in socio-economic and demographic factors. High mortality rate was higher among infants with uneducated mothers. The lacks of prenatal care and births handled by untrained traditional birth attendants (Hilots), and lack of poor access to well equipped birthing facilities contribute to the situation. Nonetheless, provincial IMRs for Infants and Under Five Children were still below the regional rates in 2006 by 13% and 21% respectively. Only Aurora General Hospital provided Newborn Screening Services, while all private hospitals located in Pagadian City were providing Newborn Screening. Poor BF and complementary feeding practices among mothers remains a priority concern. 2.3.5 Maternal Mortality Result of the National Demographic and Health Survey illustrated an improved mortality rate of the country from 1991 to 1997. Recent study based on the maternal causes of deaths in the civil registry estimated MMR at 138 per 100,000 live births in 2002. Despite the improved countrys picture of MMR based on survey and study, Zamboanga del Sur on the other hand, has a higher maternal mortality rate (MMR) in 2006 than the regional rate by 27%.
The province has 16 registered maternal deaths with an MMR of 93.56 per 100,000 live births while the regional MMR recorded at 73.6 per 100,000 live births. Most of the deaths came from rural barangays of low socioeconomic status. Highest leading causes are postpartum hemorrhage (7), Pulmonary embolism (2), Eclampsia (2), Abortion (1) and Uterine Atony (1).
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Again, the issue on multi-parity, lack of prenatal care and deliveries attended by unskilled health professionals are pointed out as most contributory factors. Among the municipalities with high maternal deaths are Margosatubig, Aurora, Pagadian City, Tabina and Tigbao. It is expected to be high in Margosatubig, Aurora and Pagadian City because hospitals are located in these areas. The protocol in death registration is de facto, i.e., death is registered where it occurred. That means that all deaths registered in these areas are not truly coming only from such areas. Hence, a system needs to be established to tract Maternal Death Review in order to define the delays in maternal care. 2.4 Infectious Diseases
In an endemic mapping conducted in 2003, 3 out of 26 municipalities were found positive for Filariasis (Bayog, Lakewood and Kumalarang). Schistosomiasis is endemic in 6 municipalities that belong to two ILHZs. In JSMART ILHZ, it is prevalent in the municipalities of Aurora, Tambulig and Ramon Magsaysay while at Yllana ILHZ it is positive at the municipalities of Molave, Mahayag and Dumingag. The Province of Zamboanga del Sur and City of Pagadian are endemic of Rabies. Wounds secondary to animal bites belong to the top leading cause of morbidity. It also has become a leading cause of consultation among government hospitals designated as Animal Bite Treatment Centers (ABTCs) in the province. On leprosy, the province is consistently declining its prevalence rate in 2005 and 2006 which is .48/10,000 population and .41/1000 population respectively. This is an indication that we have coped with the elimination level of less than one (1) case per 10,000 population. What is notable in the province is the zero deformity grade which means that patients sought early consultation before physical deformities set in. Malaria is a persistent mosquito-borne infection, affecting seven (7) municipalities with a total of 94 barangays in the province. Highly endemic municipalities are Bayog, Midsalip, Lakewood, Dumingag, Kumalarang and Tigbao. Municipalities of Bayog, Midsalip, Lakewood constitute 60 percent of the risk share, and likewise the highest 3 areas which consistently contributed to the reported cases of malaria.
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Disease transmission is perennial but generally higher during the rainy season than the dry season. An NGO, Global Fund Malaria component provide support to municipal and Provincial Malaria Program. Capillariasis is one of the causes of parasitosis that continue to affect three (3) municipalities (Dumingag, Midsalip and Bayog) in the province. The tiny infective worm is Capillaria Philippinensis. Capillariasis was first noted in the province in 2004, after an outbreak of diarrhea was reported in Barangay Gumpingan, Municipality of Dumingag. It is believed that Capillariasis in Zamboanga del Sur is a spill-over effect of Zamboanga del Norte, where the disease is widely endemic in some municipalities. A main river (Ecuan River) and other tributaries connect the two provinces. Increasing incidence in Bayog, Emerging disease in the province, Ecuan River connects Zamboanga del Norte and Zamboanga del Sur provinces. Tuberculosis (TB) is still a major health problem in the prvince. TB is 7 th leading cause of mortality in 2007, although, in 2007, it is no longer among the top 10 causes of illness. Other respiratory diseases are among the top causes of sickness and death in the province. Just like the Philippines, there is an apparent low and slow progression of the HIV infection in the province, as there has only three reported cases until 2006. In late 2005, one person with AIDS was confirmed and treated at the Zamboanga City Medical Center. In 2006, two persons (couple) were identified as HIV positive in the Provincial Hospital located in Pagadian City. There is poor contract tracing of partners of these HIV positive cases, and limited monitoring of condition of their children. The two and their two children were referred to San Lazaro Hospital for treatment. However, very limited care and support services provided. The geographic location of the province being part of the long coastline of Zamboanga Peninsula and its easy accessibility by trade routes on land and water from Zamboanga City, Davao, Cagayan de Oro City, Cotabato and Lanao Provinces make it vulnerable to the threat of Avian Influenza. Smuggling of birds , eggs of game fowls, poultry and poultry products from infected Southeast Asian countries has a probability of entry to the province via there routes. The number of dengue cases has remarkably decreased from 529 to 271 from 2005 to 2006; while, deaths decreased from 9 to 8 during the same period. In 2007, Pagadian City reported the highest number of cases of Dengue which is 175. In the province, among the municipalities with high incidence of this
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disease were Margosatubig 47, V. Sagun 14, Tabina 16, Dinas 13, Labangan 13, and San Pablo 11. Dengue cases persist year-round but with tendencies to increase during rainy season.
2.5
Child Health
Expanded Program on Immunization (EPI) is a critical public health intervention and remains the most effective strategy in reducing illnesses and deaths among children especially from the most common childhood diseases, such as Tuberculosis, Diphtheria, Pertussis, Tetanus, Measles, Hepatitis B and Poliomyelitis. Based on the results of Operation Timbang (OPT) 2007, the prevalence rate of malnutrition among preschool children 0-71 months (0-below 6 yr. old) in the province is 12.40% (11,845 children). More than half of these children (59%) belong to the age group 2 to below 5 years old, which are divided in the following age bracket: 24-35 mos. 20%, 36-47 mos -21% and 48-59 mos.-18% There are 14 municipalities recognized as nutritionally-at-risk in terms of high prevalence. Top 5 municipalities are Tabina (19.92%), Tigbao (19.49%), Lapuyan (19.35%), Pitogo (18.97%) and Dumalinao (18.64%). Causes of high incidence of malnutrition in these municipalities include having large family size, poor caring behavior of mothers. Another contributory factor is use of inaccurate weighing scales during OPT. The prevalence of breastfeeding (BF) in the province based on the 2006 FHSIS is 90.23 percent. This means that 90.23 percent of infants seen at 6 th month were breastfed. Based on monitoring and actual interviews, urban children are less likely to be breastfed compared to rural children. Children of mothers in the wealthier households are better educated and are likely to breastfeed their infants. Breastfeeding practice is poor among those infants delivered by trained personnel than those TBAs. Issues on adolescent health care still revolve around the less attention given to adolescent population. It has been noted that adolescent-related health programs remain marginal as compared to those provided to other age groups. The sector
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is most susceptible to drug addiction and sexually-transmitted diseases (STDs), teenage pregnancy, pre-marital sex which are due to curiosity, adventurism and peer pressure. Our local data shows that women 18-19 years old who are getting married are pregnant. Thus, improving health services and health care delivery to adolescent population is a key objective under the present thrusts. The Integrated Provincial Health Office had been considering the establishment of Adolescent Clinics or Teen Centers but failed because of many constraints. 2.6 Maternal Health
The national target for pregnant women having four (4) or more prenatal visits is at 80 percent. However, the provincial data in 2006 only recorded 76.74 percent, falling below the national target. This level of accomplishment is also below compared to 2001 (78.55 percent). Though the current achievement level is still not very far from the national average, certain municipalities do have very low quality pre-natal care. This fact may have some bearing on the quality of maternal and newborn care, and breastfeeding outcomes in the future. In 2006, 39.51 percent of pregnant women were given complete Iron dosage. About the same proportion of lactating women were also provided complete Iron dosage (39.7%). On Vitamin A supplementation, 8.07 percent of pregnant women and 61.5 percent of lactating mothers were given Vitamin A capsule. These figures may not be the true picture of the province, as it is believed that there could be under-recording of Iron and Vitamin A Supplementation among target womens group. is foremost in attaining reproductive health because it allows couples to freely CONTRACEPTIVE METHOD MIX (%) decide on the number and spacing of their children. Among the currently married women in 2006, it was found that 42.19 percent use any form of contraceptive method and 57.81 percent do not use any form of contraceptive method at all. Of all the current users in 2006, Pills got the highest of 41.26% followed by IUD 23.63%, LAM 12.56%, Injectable 8.75%, NFP 8.48%, Condom 4.51%, BTL 0.74% and VAS 0.04%. The lack of OB-gyne/ Physician in public hospitals contributes to the low coverage on BTL. At present only Marie Stopes, a private institution, visits the province occasionally to provide BTL services. 2.7 Healthy Lifestyle and Management of Health Risk
Page Figure 3-5 Planning Family
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Death rates due to hypertensive disease (HPN), other forms of cardiovascular disease (CVD) and ischaemic heart disease (IHD) increased enormously for men and women, being the 2nd, 4th and 6th leading causes of death in the province, respectively. These chronic and non-communicable diseases which are largely attributed to life style are becoming a major health problem in the province; hence, the continuing need for immediate and intensified preventive measures considering the staggering and astronomical cost of medical care that is beyond the reach of the general population. As lifestyle- predisposed diseases, it calls for the active involvement of the affected person in the preventive program. 2.8 Health Service Delivery
The Health System of the province is divided into two (2) services: the Public Health and the Hospital Services. Public Health provides primarily preventive and promotive services, while the hospitals provide mainly curative and rehabilitative care.
The Integrated Provincial Health Office (IPHO) provides technical supervision over health units in the city and municipalities. It also provides administrative and technical supervision over six (6) hospitals devolved to the provincial government. It serves as the planning for health in the province and conducts monitoring and evaluation throughout the province. 2.8.1 Integrated Provincial Health Office The IPHO that is mandated to oversee the Provincial Health System does not have a Health Human Resource Development Plan. It is headed by the Provincial Health Officer II. A Medical Specialist III position, which is currently vacant, acts as Chief of the Technical Division. There are five (5) nurses, one (1) dentist, two (2) supervising sanitarians and one (1) statistician composing the Technical Division. They form as Health Program Managers. After the reorganization of the provincial government in 2002, IPHO was left with one administrative plantilla position: storekeeper. The Administrative Section provides support to the PHO II and the Technical Division. Two (2) Administrative Officers and one (1) Nutritionist are detailed to the IPHO from the Provincial Hospital. The Technical Division provides data analysis and feedback to Health Units but because of lack of
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skills in this area, much remains to be done. Training needs identified include Computer Literacy, Planning Skills Training, Program Management and Supervisory Skills Training, Data Analysis, Epidemiology, Presentation Skills Training, Health Economics, Health Promotion Skills, and Personality Development. The Administrative Section provides support in terms of communication, transportation, documentation, encoding, bookkeeping, records, and health resource development. It lacks manpower hence its effectiveness is diminished. It is deficient in the following equipment, namely: photocopier, fax machines, scanner, camera, document camera, computer units with internet connection, laptop (WIFI ready). Knowledge management is inefficient because of lack of program for data banking. The lack of Provincial Medical Technologist hinders the establishment of a Provincial Validation Center for sputum and malaria microscopy. The lack of Provincial Pharmacist is a also reason for delays in implementing the Botika sa Barangay program. On monitoring and evaluation, high cost of transportation, human fatigue, personnel safety, and bad road conditions especially in rural barangays, justifies the need for a monitoring vehicle. It can also facilitate delivery of health commodities to the municipalities, as well as for Disaster Response. Drugs, medicines and other health supplies from DOH, Donor agencies, and NGOs are allocated for the province need proper storage prior to their distribution to RHUs. Thus, ensuring the safety, maintain potency and efficacy of drugs and medicines is imperative. At present, the IPHO warehouse needs major repair. 2.8.2 Local Health Facilities The province has a dual health system which consists of the public sector and the private sector. The public sector is largely financed through a tax-based budgeting system and where health care is generally given free, although socialized user fee charges have been introduced recently for certain type of services. The private sector mainly composed of hospitals is market-oriented, where health care is paid through user fees. The province including Pagadian City has an average ratio of 1785 people per hospital bed of which is above the standard ratio of 1000 per 1 hospital bed. Most of the indigents and underprivileged seek hospital care in the government hospitals while the private sector owns most of the beds caring for the upper and middle class constituents. The lack of hospital bed is worsened by the fact that the provincial and
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district hospitals have inadequate budgetary support after devolution and have lost managerial autonomy. More patients are forced to bypass local government hospitals and seek out better equipped and better-staffed national government hospitals. Most of the national government hospitals are in urban and better off areas outside of the province, worsening the inequity in access to these facilities by residence of poorer and rural areas. There are inherited challenges after the devolution. These are budget deficit, inadequate manpower, inadequate infrastructure development in municipal hospitals, inadequate laboratory and diagnostic equipment, lack of medicines and supplies and long lead agencies in the procurement of supplies and medicines. Old beliefs and practices that treat government hospitals as provider of free health services and too much dependence on political leaders in seeking special treatment are the issues and concerns that merits due attention. Just like government hospitals, Rural Health Units (RHUs) also face great challenges in terms of access in the delivery of accessible, efficient, equitable and quality health services to the populace due to budgetary constraints. These public health facilities have inadequate laboratory supplies and equipments, medicines are scarce and inferior. Existing health facilities building and structure need to be improved and renovated to provide health care. Most of these health facilities have vehicles like ambulances for community outreach and referral. But its acquisition, use, and maintenance still pose problems because its priority and intended use still remain an issue. Moreover, communication facilities are still weak in most RHUs having to rely on single side band for official communication. Since public primary facilities are frequented by the poor, improving their quality services is tantamount to improving health condition of the poor and the under served. These would also reduce the bulk of patients who will seek consultation in public hospitals.
There are 190 Barangay Health Stations (BHS) in the province. Among the three inter-local health zones, Yllaa Health Alliance ILHZ has the most numbered BHS of 92. In 2006 the ratio of BHS to population is 1:4,670. Mostly of the BHSs in all areas of the province need to be renovated. There are also municipalities that propose for construction of new BHS to extend health services to many constituents. These BHSs have the same predicament with the Rural Health Units in terms of unavailability of medicines and equipments.
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Sixty-seven percent of hospitals in the province are privately owned. Most of the private facilities offer good quality services; however, high costs of care remain a big burden. Relative low cost of care is still a significant advantage of government facilities over private ones. The private sectors involvement in maintaining the peoples health is enormous. Public hospitals need improvement in physical structure, equipment, supplies and human resource. There are 16 private hospitals/clinics in the province, majority of which are located in Pagadian City. As to service capability, one (1) is Level 3, four are Level 2, 11 are Level 1 and 1 is infirmary. The total number of bed capacities of the private hospitals/clinics reached 185; while, government hospital beds total 497. In all, bed-to-population ratio is 1:1,785. 2.8.3 Health Human Resource Based on the FHSIS and statistical survey, there are 191 medical doctors in the province of which 27 (or 14%) are in the public health, 40 (20%) are in the government hospitals and the rest are private practitioners, leaving some municipalities without doctors to attend to their health needs. Somehow, the DOH deployed physicians in doctor less municipalities (DTTB) of whom the province is a beneficiary, but in this case, there is one thing to consider if the contract ends. The municipalities are not assured of the continuity of their services and aside from that some LCEs do not bother to allocate budget for this position as well as the differing views of giving health services between the doctors and LCEs. Among the nurses and midwives and medical technologists, 60 percent are employed by LGUs but most of them are applying/ going abroad, leaving their positions vacant and where some LGUs do not prioritize to allocate budget, and if they have, they divert it to other activities/ projects. For dentists, the province has a total of 49 dentists, of which 30 (61%) doing private practice, 6 (12.4%) rendering dental services to school children and 13 (26.5%) in the public health. Out of the 26 municipalities and 1 city, 12, municipalities have dental clinics of which 3 of these clinics are having visiting dentists only. The province socio-economic and political situations have not helped much in retaining skilled health professional in the country.
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On the other hand, there are 31 Sanitarians in the entire province but even then, these could not cope up with the sanitation demands because of lack of training s as well as due to political interest. This also holds true to 2,954 Barangay Health Workers (BHWs) and 854 Barangay Nutrition Scholars (BNS) assisting at the grassroots level. Another thing is the designation only of Municipal Nutrition Action Officer as well as for the Health Education and Promotion Officer giving extra workloads to health personnel. 2.9 Health Financing 2.9.1 Health Care Expenditure Budget allocation of 6.75 percent of the Internal Revenue Allotment (IRA) for health activities under the General Fund were allocated taking into consideration, not only budgetary allocation for IPHO, Provincial and District Hospitals but also from the Provincial Governors Office, Provincial Social Welfare and Development Office and even in the Annual Investment Plan (AIP) Allocation of 17 percent for health sector. Health activities for hospital patients are benefited in the form of financial assistance, PhilHealth reimbursements, provision of medicines and discounts on hospital bill. In 2006 first quarter, there was as an increase in health expenditures in the amount of PhP87,938,943.97 compared to PhP83,332,168.24 in 2007. These expenditures were specifically allocated for various medicines used in medical outreach missions in far-flung barangays. 2.9.2 Social Health Insurance (SHI) Universal Coverage Provision of basic health services is a national priority program of the government; thus, the provincial government aims to target 100 percent coverage of poor population by year 2012 and sustaining enrollment of families each year. Budgetary requirements for counter parting by LGUs and PHIC for the next 5 years as well as is determined vis--vis projected LGU incomes of RHUs in the form of Outpatient Benefit Package (OPB) and PhilHealth Capitation Fund (PCF). Some LGUs implemented partial subsidy scheme. However, they opted to adapt different schemes per municipality as authorized through a local ordinance. Some LGUs require counterpart fund from component Barangays though sharing is not clearly stipulated in the PHIC-LGU Memorandum of Agreement (MOA). Nonetheless, total LGU Premium
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counterpart bears out to be the total LGU Share as the total amount remitted to PHIC. It is noted that some LGUs decided to stop the Indigent Program primarily because of increasing premium. It is also observed that poor constituents still seek assistance from local public officials for transportation and even food while hospitalized.
The target for PhilHealth coverage in the Formal and Informal Sector is estimated as 25-30 percent of the total population, which includes the Employed under the Government and Private Sector as well as the Selfemployed or the Individually Paying Members. 2.9.3 PHIC Accreditation of Hospitals The Outpatient Benefit Package (OPB) was exclusively designed to augment RHU budget for health in a form of PhilHealth Capitation Fund (PCF) with an equivalent value of P300 per family per year. In 2002, the first OPB accredited in Region 9 is the RHU of Ramon Magsaysay, ZDS which is until now has sustained its accreditation. Two other RHUs then followed but were unable to sustain primarily because the PCF share due for RHU personnel was not granted. The LGUs are expected to formulate and enact Implementing Rules and Regulation (IRRs) based on PHIC Circulars, MOA, and auditing and accounting rules. However, no LGU has come up with one yet. The TB Dots and Maternity Care Package (MCP) were included in the list of other financing source of the LGU, however, most of the LGUs did not appreciate its revenue or may not convinced of this potential to increase their income. Record shows that only San Pedro RHU of Pagadian City is TB-DOTS accredited in the province for the past 2 years.
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Chapter PUBLIC HOSPITALS IN ZAMBOANGA DEL SUR: 3 A SITUATIONER

With a total of 191 public and private physicians provincewide, there is only one doctor for every 4,787 Zambosurian and one hospital bed for 2,540 provincial constituents in 2007. Comparatively, the provinces bed-to-population ratio is lower than other provinces in the country. However, there are other medical establishments in the province that includes 30 RHUs, 190 Barangay Health Stations (BHSs), and about 490 Health & Nutrition Posts (HNPs). The health conditions in the province would have improved a lot had all doctors opted to stay in the province or the country. A number of physicians, nurses and medical personnel working in the province opted to go to the U.S., Europe and the Middle East where they earn ten times as much as their salaries in the province, leaving only a few doctors attending to the needs of the large population in Zamboanga del Sur. Thus, its worthy to note on the adequacy of hospital beds in the province, as hospital budgets are tied up with the number of beds authorized for a particular health facility. Expectedly, as in majority of localities in the country, the provinces bed-to-population ratio remains significantly lower than the standard of one bed per 1000 population. Increasing the level of authorized bed capacities (ABCs) would mean more budgetary allocation for operating expenses, capital outlay and personal services. 3.1 Hospital Bed Requirements
Determining adequacy of hospital beds throughout the plan period requires projection of population within the catchment area. Future bed requirements can be determined by multiplying present bed requirements and the ratio of future population to present population. 3.1.1 Projected Primary and Secondary Catchment Population
The provinces total population based on the 2007 Census Report was 914,278. With a computed average annual growth rate (AAGR) of 1.28% per annum from 814,247 in 2000, the provincial population will reach 974,259 by 2012 and 1,012,452 by 2015. In the primary catchment area, the total population of 329,022 in 2007 is projected to reach 350,679 by 2012 and 364,352 by 2015.
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In the secondary catchment area, the total population of 585,256 in 2007 is projected to reach 623,781 by 2012 and 648,100 by 2015.
Table 1. Projected Primary and Secondary Catchment Population: 2012 & 2015 Population Catchment Area City/Municipality 2007 2012 2015 (Census) (Projected) (Projected) Pagadian City 161,312 A. Primary Catchment 171,930 178,634 Area* Labangan, ZDS 37,598 40,073 41,635 Tukuran, ZDS 36,591 39,000 40,520 Dumalinao, ZDS 29,732 31,689 32,925 Tigbao, ZDS 18,598 19,822 20,595 Guipos, ZDS 19,616 20,907 21,722 San Pablo, ZDS 25,575 27,258 28,321 Sub-total 329,022 350,679 364,352 Aurora, ZDS 47,177 B. Secondary Catchment 50,282 52,243 Area** R.Magsaysay, ZDS 25,321 26,988 28,040 Sominot, ZDS 16,367 17,444 18,124 Tambulig, ZDS 34,242 36,496 37,919 Molave, ZDS 48,215 51,389 53,392 Midsalip, ZDS 30,772 32,798 34,076 Mahayag, ZDS 44,087 46,989 48,821 Dumingag, ZDS 46,039 49,069 50,983 Josefina, ZDS 10,796 11,507 11,955 Lakewood, ZDS 18,562 19,784 20,555 Bayog, ZDS 28,707 30,597 31,790 Kumalarang, ZDS 27,280 29,076 30,209 San Miguel, ZDS 16,981 18,099 18,804 Lapuyan, ZDS 26,118 27,837 28,923 Margosatubig, ZDS 34,939 37,239 38,691 Dinas, ZDS 33,738 35,959 37,361 Pitogo, ZDS 25,231 26,892 27,940 Tabina, ZDS 23,798 25,364 26,353 Dimataling, ZDS 26,902 28,673 29,791 V. Sagun 19,984 21,299 22,130 Sub-total 585,256 623,781 648,100 26 Municipalities + 1 Total 914,278 974,459 1,012,452 city Average Annual Growth Rate (AAGR) 1.28% for the Period 2000-2007 *- refers to city/municipality serviced by Level 2 hospitals **- refers to other geographic areas that have access or contiguous to the primary catchment area/s
3.1.2
Inventory of Hospital Beds and Bed-to-Population Ratios
Total hospital beds in the province as of December 2007 was recorded at 395, including about 35 beds that existing hospitals are currently applying for license to operate/expand.
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3.1.2. a
Existing Hospital Beds
Existing hospitals include eight (8) government-owned facilities with a combined ABC of 175. The ZDSPH has the highest number of authorized beds of 50, though the facility is operating at more than 100 beds. The Aurora General Hospital (AGH) has also an ABC of 50; while, both the Mahayag and Lakewood Municipal Hospitals have ABCs of only 5 each. About 14 of existing hospitals are privately-owned and are located in four (4) municipalities and in the city of Pagadian, with a combined ABC of 185. The Pagadian City Medical Center (PCMC) has the highest ABC of 50; while, the Euser Medical Clinic in Tambulig has the lowest of 5. In all, existing government and private hospitals in the province has a combined ABC of 360. 3.1.2. b Hospitals Currently Applying for License to Operate
About 35 additional beds are to be authorized pending issuance of license by DOH.

Table 2. Inventory of Hospital Beds in Primary and Secondary Catchment Areas: 2007 Hospitals A. Existing Hospital Beds A.1 Government Hospitals 1. Aurora General Hospital 2. Kuta Major Sang-an Station Hospital 3. Mahayag District Hospital 4. Tambulig Municipal Hospital 5. Zamboanga Del Sur Provincial Hospital 6. Lakewood Municipal Hospital 7. Dinas Municipal Hospital 8. Margosatubig Regional Hospital Sub-total Government (1) A.2 Private Hospitals 1. Tagaloguin Clinic 2. SS Lumapas Hospital (New) 3. Blancia Hospital 4. Igano Community Hospital 5. ZDS Health Services Coop. Hosp. 6. Hofilea Clinic 7. St. Francis Clinic 8. Metro Pagadian Hospital, Inc. 9. Borbon General Hospital, Inc. Zamboanga del Sur Province Location ABC* Level of Hospital
Aurora Labangan Mahayag Tambulig Pagadian Lakewood Dinas Margosatubig
50 20 5 10 50 5 10 25 175 6 15 10 22 10 10 6 10 15
Secondary Primary Primary Primary Secondary Primary Primary Secondary
Dumingag Molave Molave Molave Pagadian Pagadian Pagadian Pagadian Pagadian
Primary Primary Primary Secondary Primary Primary Primary Primary Secondary

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10.Pagadian City Medical Center 11.J. Cabahug Hospital 12.Euser Medical Clinic 13.Pagadian Community Hospital 14.Singidas Medical Clinic Sub-total Private (2) Sub-total Government + Private (3) B. Hospitals Currently Applying for License to Operate 1. Pagadian City Medical Center 2. Other Secondary Hospitals 1. Other Primary Hospitals Sub-total Application (4) C. Inventory of Hospital Beds (IHB)=(3)+(4) *- Authorized Bed Capacity Pagadian Pagadian Tambulig Pagadian Lakewood 50 10 5 10 6 185 360 20 10 5 35 395
2008-2015
Tertiary Secondary Primary Secondary Primary
Pagadian Pagadian Pagadian
Tertiary Secondary Primary
3.1.3
Bed-to-Population Ratios (BPR)
As of 2007, the provincial bed-to-population ratio is computed at .43 indicating a ratio lower than the ideal of 1.0. Obviously, the inventory of hospital beds fall short of the required one bed per 1000 population.
Table 3. Provincial Bed-to-Population Ratio: 2007 Particular Inventory of Hospital Beds (IHB) Population (P) Bed-to-Population Ratio* (BPR)=(IHB/P)x1000 *- if BPR is less than 1.0, then the BPR criterion has been met Value 395 914,278 .43
3.1.4
Projected Bed Needs (PBN)
Given the projected population levels, projected bed needs (PBN) can also be determined using the same standard ratio of one hospital bed per one thousand population. As such, the PBN are 974 and 1,012 for years 2012 and 2015, respectively.
Table 4. Projected Bed Needs (PBN): 2007, 2012 & 2015 2007 Population (P) 914,278 Projected Bed Need* (PBN)= P x 1/1000 914 *- 1 hospital bed for every 1 thousand population Particular Value 2012 974,459 974 2015 1,012,452 1012
3.1.5
Unmet Bed Needs (UBN)
Existing and projected unmet bed needs (UBN) are computed as 514 beds in 2007, 574 beds in 2012, and 612 beds in 2015.
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Table 5. Unmet Bed Needs (UBN): 2012, 2015 Particular Projected Bed Needs (PBN) Inventory of Hospital Bed (IHB) Unmet Bed Need* (UBN)= PBN-IHB *- 1 hospital bed for every 1 thousand population 2007 914 400 514 Value 2012 974 400 574
2008-2015
2015 1012 400 612
3.2
Occupancy Rates of Existing Hospitals
The average occupancy rate of existing hospitals in the province is recorded at ___ percent. This indicates overutilization of said health facilities as against their authorized budgets and suggests the need for more ABCs in the province to be able to meet service standards during the plan period.
Table 6. Overall Average Occupancy Rates of Existing Hospitals for the Past Two Years: 2006, 2007 Occupancy Rate Existing Hospitals ABC Average (2 2006 2007 years) Aurora General Hospital 50 Kuta Major Sang-an Station Hospital 20 Mahayag District Hospital 5 Tambulig Municipal Hospital 10 Zamboanga Del Sur Provincial Hospital 50 Lakewood Municipal Hospital 5 Dinas Municipal Hospital 10 Margosatubig Regional Hospital 25 Overall Average Occupancy Rate of Existing Government Hospitals Source: IPHO, ZDS
3.3
Hospital Accessibility and Strategic Location
Accessibility of a hospital facility in terms of physical distance from a lower-level level health facility, as well as its strategic location given a catchment area are important determinants for decision makers in so far as feasibility and viability of establishing or developing/upgrading a higher level health facility. For a facility to be considered cost-effective, it should be less than an hour of travel from another health facility. On the other hand, the facility should be readily accessible by the usual means of transportation, as well as, strategically (geographically) located based on existing road network vis--vis catchment population.
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3.3.1
Travel Time From Provincial Health Facility to Existing Government Hospitals
The average travel time from the provincial health facility to any existing public hospital is recorded at 52 minutes, indicating accessibility to such a facility as a referral health institution at the provincial level.
Table 7. Travel Time from Provincial Health Facility to Existing Government Hospitals Travel Time to Existing Government Hospitals Location Provincial Health Facility (In Hour & Minutes) Aurora General Hospital Aurora 0 hour 45 minutes Kuta Major Sang-an Station 25 minutes Hospital Labangan Mahayag District Hospital Mahayag 0 hour 55 minutes Tambulig Municipal Hospital Tambulig 0 hour 50 minutes Lakewood Municipal Hospital Lakewood 1 hour 30 minutes Dinas Municipal Hospital Dinas 1 hour 0 minutes Margosatubig Regional 1 hour 30 minutes Hospital Margosatubig Average Travel Time 0 hours 52 minutes
3.3.2
Accessibility by Usual Means of Transportation
The provincial health facility is readily accessible by means of land transportation as existing road network can facilitate multi-point access, albeit some road segments/sections require rehabilitation and/or upgrading to reach the optimum service level.
Table 8. Accessibility of Provincial Health Facility Criterion Yes No Remarks Existing road network facilitates access to the provincial health facility, though some sections require immediate rehabilitation and/or upgrading for greater access.
Accessibility (Accessible by the usual means of transportation during most part of the year)
3.3.3
Strategic Location In Terms of Catchment Areas
In terms of strategic location, the provincial health facility is not isolated nor biased to a particular district as it is located in Pagadian City which is centrally located as far as geographic location is concerned.
Table 9. Strategic Location of Provincial Health Facility Criterion Strategic Location Yes No Remarks The provincial health facility is located in Pagadian City which is
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geographically central to both the 1st and 2nd congressional districts.
3.4
Acceptable Track Record by Hospital 3.4.1 Compliance to Licensing Requirements
Historically, the provincial health facility has complied with licensing requirements despite resource limitations inherent to LGUs. There are no major violations ever committed by the facility, except for minor deficiencies that were eventually rectified and complied with.
Table 10. Track Record of Provincial Health Facility Good Compliance to Existing License Provincial Health Location Requirements Facility Yes No
Remarks Despite limitations on resources, the provincial health facility endeavors to comply with established licensing requirements by DOH.
ZDS Provincial Hospital
Pagadian City
3.5
Hospital Personnel Complement 3.5.1 Existing Hospital Personnel (All Hospitals) The total number personnel of the Zamboanga del Sur Provincial Hospital reached 175 including personnel from the four (4) municipal hospitals, namely: the Dinas Municipal Hospital (DMH), Lakewood Municipal Hospital (LMH), Mahayag Municipal Hospital (MMH), and the Tambulig Municipal Hospital (TMH), all of which are part of the provincial government hospital system.
Of the total, ZDSPH has 114 personnel; while, both the LMH and MMH have 15, DMH has 14 and TMH has 17. As to position classification, 32 belong to administrative positions, 27 are medical doctors, 44 are nurses, 31 are clinical support personnel, and 41 are technical support personnel. (Please refer to Annex G for details).
Table 11. Number of Personnel (All Public Hospitals in ZDS): 2008 Positions Administrative ZDSPH 18 DMH 3 LMH 4 MMH 3 TMH 4 Total 32
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Medical Doctors Nurses Clinical Support Technical Support Total 21 28 19 28 114 1 4 3 3 14 1 4 3 3 15 2 4 3 3 15 2 4 3 4 17
2008-2015
27 44 31 41 175
3.5.2 Required Hospital Personnel Complement A 100-bed capacity hospital facility (tertiary level) requires a total of 329 personnel, consisting of 53 administrative, 61 medical, 86 nursing, 50 clinical, and 79 technical personnel. Administrative positions are needed for the maintenance of the building and all other facilities within the hospital compound, as well as additional staff for medical records, PhilHealth, billing & supplies, and supplies & procurement. Medical specialists are needed to head the different medical departments to cater to the different areas or fields of specialties; while, nursing positions are needed to address the wide gap on nurse-to-patient ratio which is only 1:5. Clinical support personnel are necessary to be able to respond to the increasing number of patients seeking medical care and laboratory examination and analysis. Medical equipment technicians are required to operate and maintain newly acquired medical equipment donated and/or purchased for use by the medical health facility.
Table 12. Number of Personnel in ZDSPH and Proposed ZDSMC ZDSMC Positions ZDSPH Gap (Proposed) Administrative 32 53 21 Medical Doctors Nurses Clinical Support Technical Support 27 44 31 41 61 86 50 79 34 42 19 38
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Total 175 329 154
2008-2015
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Chapter THE ZAMBOANGA DEL SUR MEDICAL CENTER 4 (Health Facility Development Project)
4.1 Rationale & Situationer The Zamboanga del Sur Provincial Hospital (ZDSPH) has been issued a secondary level DOH License with an authorized bed capacity (ABC) of 50, despite the fact that historical occupancy rate was already more than 200 percent of its ABC for a number of years. Understandably, patients from the catchment/component municipalities, and even from the neighboring regions/provinces, sought the services of the hospital, it being the referral hospital under the established Inter Local Health Zone (ILHZ) System in the province. Thus, ZDSPH is serving more than a hundred patients daily on the average. Hospital Statistics Report as of June 2008 reported that the average daily admission reached 639 patients. From January to June of 2008, the hospital had 13,769 out-patients and 3,607 in-patients with an average occupancy rate of 162.48 percent. Of these patients, 1,507 in-patients and 2,294 out-patients were provided subsidies under the National Health Insurance Program (NHIP) through the Philippine Health Insurance Corporation (PHIC). 4.1.1 Adequacy of Hospital Beds
To meet current and future care call of the rapid growth of population of the province of Zamboanga del Sur, there is a great need to upgrade the Provincial Hospital from its present classification into a Tertiary Hospital with the capacity of 100 to 150 beds, otherwise the quality of health care and services will be compromised. 4.1.2 Appropriateness of Provincial Hospital Services Provided
It is worthy to note on the appropriateness of services being provided by the ZDSPH in order ascertain the current capacity level of the health facility vis--vis projected service level standards of a tertiary level facility. The situationer has implications on the sufficiency and competence of existing hospital center as to administrative, clinical, nursing and ancillary services. 4.1.2 .a Administrative Services
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Administrative support services were provided in accordance with the Civil Service Commission (CSC) guidelines, policies, rules and regulations and with internal guidelines and policies formulated by the Provincial Hospital through consultation and integration of shared goals and values in conformity with the rules and regulations of the Provincial Government. However, given resource limitations and a stretched budget due to over-capacity issues, the provision of adequate and timely financial and support services such as accounting, billing, budget, cashiering, housekeeping, laundry, personnel, property and supply, security, transport, engineering and maintenance remained wanting, including the provision of adequate personnel benefits. At the operational level, inadequate administrative support has compromised quality clerical and logistic support services that are critical to the prompt and appropriate provision of various services to providers, clients, other government and private agencies and professional groups. A Grievance Committee was organized and tasked to attend to matters concerning personnel relations and discipline by hearing personnel complaints and grievances as well as client complaints and resolving conflicts between or among departments or units or individual employees. Committee actions were guided by CSC rules and regulations including Sangguniang Panlalawigan resolutions and/or ordinances, Republic Act No. 7305, etc. Unresolved complaints/conflicts were elevated to the Provincial Grievance Committee. The Hospital Waste Management Committee (HWEMC) and the Preventive Maintenance and Disaster Control Committee (PMDCMC) were also created to respond appropriately when the need arises. 4.1.2 .b Clinical Services
The Medical Clinical Services responded to the urgent problems regarding hospital operations and attended promptly to emergency cases especially from depressed areas following established referral system procedures among public and private hospitals and medical centers.
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Patients coming from the different municipalities of our province including the municipalities of Zamboanga Sibugay, Lanao del Sur and Zamboanga del Norte were being served by the hospital. In 2007, there were 26, 427 out-patients and 7,847 in-patients who were admitted as having Surgical, Medical, Pedia, and OB-Gyne cases. Of the out-patients, 14,696 were seen by Dentists and about 39,854 patients were served with laboratory services. 4.1.2 .c Nursing Services
Nursing services are adequately provided as the service unit favorably benefited from the services of nursing interns from existing nursing schools in Pagadian City.
4.1.2 .d
Ancillary Services
Pharmacy Services. Active members of the hospitals pharmacy, therapeutic and other hospital clinical and support committees had uphold good linkages and networking status with the other sections of the hospital and other offices. Periodic reporting was sustained on drugs dispensed and issued to patients both for PhilHealth or Non-PhilHealth assisted by a licensed physician and dentist. Requisitions were prepared for awarded drug items and other supplies for procurement. Proper storage for all drugs, biological and medical supplies were maintained and manufacture and expiration dates and labels of drugs routinely checked. Although there were some minimal lapses and errors committed by some of the pharmacy staff, due to lack of manpower rather than negligence. Medical Records Services. Maintained the safe keeping of patients medical records that are documented accurately and in timely manner, are made readily accessible, and permit prompt retrieval of information, including statistical data. The medical records officer and the record clerk has maintained the appropriate medical records of patients who are treated, evaluated as inpatient, ambulatory care patients, or emergency patients. As such, medical records contains sufficient information
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as to the identity of patients, support the diagnosis, justify the treatment, and document the course and results accurately for them to act promptly to requesting party who ask for issuance of Medico Legal, Medical Certificate or document/s for court hearing. Dietary Services. With their present work force, the Dietary Unit has promoted optimal nutrition of patients and hospital personnel whose tour of duty is on a 24-hour schedule, through provision of high quality and nutritious foods. Although, the dietary services experiences tight budgetary constraints vis--vis soaring prices of commodities, careful planning and wise procurement made possible the provision of nutritious and fresh foods required for a balanced and satisfying meal. Medical Social Services. The ZDSPH extended services to indigent patients for assistance by referring/recommending them to different offices/officials like PSWDO, PCSO, CIAF and other national/provincial/city/municipal officials. Evaluation, investigation and case study preparations for each patient were carried out for the proper classification of indigent patients. It is encouraged that Universal Coverage for social health insurance in the province must be significantly expanded to maximize benefits from both the supply and demand side.
4.1.3
Sufficiency and Competence of Provincial Hospital Personnel 4.1.3 .a Administrative Services
Shortfalls in the area of administrative support require the hiring of additional health manpower. For administrative services, the existing 11 personnel shall be increased to 25; while, the existing 9 personnel for maintenance, housekeeping, engineering services shall be increased to 57. There is felt need to hire regular employees for maintenance and related works rather than outsource them from service providers. 4.1.3 .b Clinical Services
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Plantilla/regular positions under the ZDSPH include the following: Physicians (20), Dentist III (1), Dental Aide (1), Medical Laboratory Technician (10), Laboratory Aide (3), and Radiologic Technologist (1). However, there is only one (1) OB-Gyne Specialist working as full time in the hospital, two (2) General Surgeons and two (2) Internists and one (1) Pediatrician. Given the ideal number of clinical staff, and to ensure the provision of quality curative services, there is an urgent need to hire the services of Medical Specialists offering seven (7) major clinical specialties for the provincial health facility. 4.1.3 .c Nursery Services
Ideally, given the actual number of beds served vis--vis ABC, the number of nurses should be increased in order to meet service level standards. 4.1.3 .d Ancillary Services
For Pharmacy Services. Nine (9) pharmacists are needed serving on a shifting 24 hours schedule. For Medical Record Services. Based on the presented scenario, there is a need to upgrade manpower complement of the record section form 1 to 4 personnel. For Dietary Services. Prompted by the very high hospital occupancy rate, there is a need to increase dietary personnel from 4 to 14 which is commensurate to the requirement of a 100-bed health facility.
4.1.4
Status of Provincial Hospital Networking and Referral System
Being a core referral hospital, the Provincial Hospital is implementing the Two-Way Referral System. Patients are regularly linked to health facilities that can best attend to their needs. This includes but not limited to direct
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patient care, use of communication facilities for updates and information gathering on available health facility services needed by patients, access to various social support services, and available mode of transportation to move patients from one facility to another. Referrals were done under the following conditions: (a) patients that needs expert advice; (b) patients that need technical examination that is not available at the health facility; (c) patients that require a technical intervention that is beyond the capability of the local health facility; and (d) patients that require inpatient care. Internal referrals were also done or within the health facility and from one personnel or another; doctor to doctor (involving different fields of specialties), resident physician to a medical specialist, Nurse to Municipal Health Officer, or a Midwife referring patients to a Public Health Nurse for the purpose of providing any of the following: opinion or suggestion, case management, and further evaluation for specialty care. On the other hand, external referrals refer to linking patients to another health facility vertical or horizontal referrals. All these referrals were of patients consent. The linkages and lines of administrative communication/supervision were managed by the ILHZ. The roles and functions of the Provincial Health Officer as coordinator, Chief of Hospital of the core referral hospital and the Municipal Health Officers of the catchments RHUs were clearly defined to ensure full operationalization of the comprehensive twoway referral systemthat is respected and adapted by all stakeholders. STAKEHOLDERS Functions as defined: a. Defined functions and responsibilities of each level of care and the agreed roles and responsibilities of the stakeholders properly observed. b. Agreed standard case management protocols (treatment protocols and guidelines) referral policies, administrative guidelines to support the referral system were followed. c. Conducted regular monitoring and supervision at all level.
d. Conducted regular evaluation of the system (e.g. quality of care, referral practices and support mechanisms) e. Enhanced establishment of a feed backing mechanism at all levels (e.g. program updates, program implementation reviews, and capability building activities).
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f. Assisted in facilitating advocacy meetings and other activities involving the key stakeholders of the referral system implementation. As a core referral health facility, the Provincial Hospital provided and maintained referral slips (clinical referral slips, return slips, discharge summary / follow-up slips), referral log book, radio communication equipment, transport, social services and monitoring system. Periodic meetings/conferences and monitoring and evaluation activities were done equipping the Provincial Hospital core referral system team members, particularly on synchronizing linkages and networking of primary and secondary referring facilities to higher level referral facilities. 4.1.7 Present State of Provincial Hospital Management Systems 4.1.7 .a Hospital Management Information System
The Provincial Hospital Information System is operated through the following: 1. For information within the hospital a. Paging system b. Memorandum and other form of communication c. Special Orders d. Meetings or conference 2. Other Offices within the province and neighboring communities a. Radio communication services managed by a trained Communication Equipment Operator II b. Providing information through letters and other form of communication by mail, email or fax through a liaison officer c. Meetings or conferences d. Advisory / Inter-office communication 4.1.7 .b Hospital Billing and Collection System
Admitted patients due for release or discharge are required to secure clearance slip from the Nurses Station duly signed by the CSR, X-RAY, ULTRASOUND, CT SCAN, PHARMACY, LABORATORY,
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DIALYSIS and MEDICARE Departments. Cashier Section issues a bill according to the patients case based on the Revenue Code of the province. The Cashier/Billing Section automatically issue Official Receipts to patients who can pay in full. For those who can not pay in full shall be referred to the MEDICAL SOCIAL SERVICE for financial evaluation before issuance of OR by the Cashier.
After payment, the Clearance Slip shall be routed to the departments concerned then validated by the Cashier/Billing for issuance of Discharge Slip. Nurses Station releases the patient upon presentation of Discharge Slip. For OPD and In-Patients, Rx/Prescriptions shall pass thru the Pharmacy Department for pricing and pay to the Cashier/Billing and for issuance of Official Receipts and back to pharmacy for dispensing. For those who cannot afford to pay, patient shall be referred to MSS for financial evaluation. For Out Patient Collections, payments are based on services rendered and rates according to the New Approved Revenue Code of the Province. Patients accounts charge to PCSO, PSWD, CIAF and etc. must be billed and signed by the Cashier and send to the different agencies concerned for collection. The Cashier/Billing issue Official Receipts for payments made by the different concerned agencies. All collections (OPD and IN-PATIENTS) are automatically remitted to the Provincial Treasurers Office. 4.1.7 .c Hospital Financial Management System
Provincial Ordinance No.12-2005 dated September 8, 2005, provided measures governing the Revised System in Fiscal Management of Hospitals repealing Provincial Ordinance No.31 s.1997 declaring fiscal and operational autonomy of hospitals and authorizing the sub-allotment of funds. Thus, effective calendar year 2006 and up to present, all financial
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transactions of ZSPH are under the care of the Provincial Government including the preparation of financial reports. Although, hospital operation is one of the economic enterprises of the Provincial Government, the books of accounts are still consolidated as one in the General Fund. Fiscal transactions of the Provincial Government starting April 2007 were already inputted in the Electronic-New Government Accounting System (E-NGAS). 4.1.7 .d Hospital Logistics Management System
The Implementing Rules and Regulation (IRR) Part A, promulgated pursuant to Section 75 of Republic Act No.9184 otherwise known as the Government Procurement Reform Act for the purpose prescribes the rules and regulation for the modernization, standardization and the regulation of the procurement activities of the government, this IRR-A covers all fully domestically funded procurement activities from procurement planning contract and termination. It is the policy of the government that procurement of infrastructure project, goods and consulting services shall be competitive and transparent and therefore should be through public bidding, except as otherwise provided in this IRR-A. It is also the policy of the government to adopt a standard and uniform set of rules and regulation governing the procurement of infrastructure projects, goods and consulting services. Government procurement principles were adhered to, as follows: 1. Transparency in the procurement process and in the implementation of procurement contracts through wide dissemination of bid opportunities and participation of qualified non-government organization. 2. Competitiveness by extending equal opportunity to enable private contracting parties who are eligible and qualified to participate in public bidding. 3. Streamline procurement process that will uniformly apply to all government procurement.
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2008-2015
Chapter STRATEGIC DIRECTIONS FOR HEALTH FACILITY DEVELOPMENT 5

5.1 Vision A center for excellence in health care and training that integrates promotive, preventive and responsive holistic curative tertiary health services. 5.2 Mission a. The Zamboanga del Sur Medical Center shall strive towards the attainment of high standards and ethics of hospital services and health care in the province. b. To establish a service oriented high caliber manpower resource training program for assured better health interventions and outcomes. c. Develop an equitable health care financing system for sustainable efficient quality health care delivery and fiscal viability. d. Maintain the symbiotic networking with private and non-government health sectors for a proactive satisfactory clinical protocol and better implementation of national health thrust programs, espousing the promotive and preventive public health concerns for effectiveness. e. Attainment of financial viability as an economic enterprise with strong commitment to its social responsibility. 5.3 Goals 5.3. 1 Overall (National/Regional) Goal
An efficient, effective and integrated delivery system for hospital services to achieve better and equitable health outcomes is instituted. 5.3. 2 Provincial Goal
To develop a specialized health care delivery system in the province with training component for the allied professions and disciplines and gradually convert the facility into a fiscally viable institution with strong networking with the private sector for sustainability and growth.
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2008-2015
5.4
Objectives a. Upgrade the medical professional capabilities through specialist-headed departments of health care and diagnostics services and support sections. b. Establish a very competent and responsive staff to answer to the challenges of a core referral hospital in the province and other areas of the region. c. Strengthen the paramedical professions training programs as the premier practicum/ training institution in the province. d. Reinforce the convergence efforts of the Inter-Local Health Zones toward a functional and very effective referral system in the public and private health sectors with active promotive and preventive health services for public health programs by the Hospital Public Health Unit. e. Financial viability through expanded health insurance coverage of our clientele and consumers of health care. f. Reduce LGU subsidies and dependence by sound fiscal management towards sustainability and unhampered growth b gradual autonomy.
5.5
Strategies a. Departmentalization of essential medical services with corresponding Specialist-Head in Internal Medicine, Surgery, OB-Gynecology, Pediatrics, Orthopedics, Radiology, Pathology, Opthalmology, Nephrology and Physiatry with enhanced capabilities of the Emergency Section and OutPatient Department and sub-specialty in Cardiology in the next 5 years through a programmed human resource training and support reinforcement. b. Procurement of additional basic equipment and upgraded diagnostic instruments, palliative and rehabilitative modalities to maximize professional intervention/s for better or excellent outcomes. c. Expansion of hospital financing system. Government Hospital shall be allowed to collect, retain and allocate revenue from socialized users fees and other forms of revenue-
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2008-2015
generating activities. c.1 Revenue enhancement through increased number of pay wards, private rooms and Doctors OPD clinics and expanded hospital services for ambulatory surgical care. Review and implement the appropriate hospital fees and charges.
c.2
c.3 c.4
A stricter collection of hospital services fees through voucher system and other effective means. More efficient utilization of the hospital income from the incomegenerating areas (laboratory, x-ray, delivery room, operating room, etc.) This can be done by decreasing the turn-around time from the Provincial Treasurers Office to the Budget Office. Also, the possibility of making hospital income as revolving funds. Expand the source of hospital revolving funds as proceeds from sales of drugs and medicines. Hospital Pharmacy needs to be upgraded and competitive to increase income from the paying public. Procurement by consignment should be established and sustained. Expand the health insurance coverage to include the Out-Patient Benefit package of PhilHealth for reimbursement by the health insurance system. Improvement of our Affiliates facilities to cater our increasing number of students learning exposure in the different hospital section for sustained upscale of affiliation revenues.
c.5
c.6
c.7
d. Strengthening of the existing government hospital networking and patient referral system to include private hospitals and private medical practitioners. Patients in our government hospital can avail of the services of medical specialist working part-time as contractees and likewise bringing in their patients for state of the art diagnostic procedures in the new hospital as the CT-Scan and palliative care in the Hemodialysis for end stage kidney ailments. The establishment of the Medical Arts Center within the provincial health facility compound at the Provincial Government Complex at Dao by 2009 for all medical practitioners in the province will augment our revenues
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42
2008-2015
from lease and space rentals of private practitioners as well as the OutPatient Benefit (OPB) package services financed by PHIC. Corollary to the above, provision of private rooms in 2009-2010 will bring in patients of private physicians to our facility, for confinement and its expected utilization of our services and revenue generation. The simultaneous development of a full complement Physical Therapy and Rehabilitation Unit by 2009-2010 will eventually establish a functional Physiatry Department in the provincial health facility.
e. Integration of public health program into our hospital services. A Hospital Public Health Unit shall be established to serve as the main venue for the provision of promotive and preventive health services in the provincial health facility. Health educators and public health nurses and staff will man this unit with strong linkage with the Inter-Local Health Zones and its programs in resource pooling and sharing. f. Developing the parks and recreational area within the hospital site in 2013-2015 will entice private investors to lease and rent spaces and sites for businesses that are related and complementary to health services. Pharmacies and health spas are potential revenue centers for the open areas surrounding the main facility, notwithstanding the early intent of food chain franchise, catering service outlets and facilities to establish thereat; possibly too, 24-hour convenient stores and mini-malls. Sports facilities for watchers and visitors are amenities very attractive and conveniently proximal to the Amusement and Heritage Complex nearby.
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2008-2015
Chapter HOSPITAL ADMINISTRATION & MANAGEMENT 6

Operating a third level health facility as an economic enterprise entails legislative support; its financial viability thoroughly studied, its professional and technical capabilities fully backed by creation of funded plantilla positions for qualified medical specialists, nurses and support services to effectively and efficiently deliver valued services by the different departments. 6.1 Hospital Management Structure
The development of a tertiary hospital/medical center revolves around a board of directors or board of trustees, as they are empowered to perform three basic functions, to wit: (1) to represent the owners or stakeholders of the medical center and provide the means of ensuring that the facility act on the stakeholders behalf; (2) to make sure that management and the medical staff function in ways that further the mission and goals; and (3) to assume responsibility of its affairs as a corporate entity. While the Board assumes ultimate accountability, it has no ability to perform the actual work of its organizational units. It has to delegate tasks and authority to the medical staff which are, in turn, directly accountable to the Board for their decisions and actions. Needless to say, the Board of the provincial health facility system must have clear, precise and transparent operations to really govern effectively the different hospital units. Ensuring the quality of patient care is the ultimate responsibility it must assume, among other responsibilities of the Board. It has to answer two basic questions: (1) does the medical center provide high-quality care, and (2) how does it ascertain that high-quality care is being provided. The other responsibilities of the Board include: envisioning and formulating organizational ends (e.g., vision/mission/goals/strategies); ensuring high levels of executive management performance; ensuring the medical centers financial soundness/viability; and the responsibility for itselfits own effective and efficient performance. The Board shall have three (3) roles: policy formulation, decision making and oversight. On policy formulation, the Board formulates policy with respect to each of its responsibilities to provide direction and as means by which authority and tasks is delegated to management and medical staff. On decision making, it must be carried out by the Board in each area of responsibility and regarding recommendations forwarded to them by management and the medical staff. The Board engages in oversight by monitoring decisions and actions to ensure they conform to policies and produce intended results.
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2008-2015
6.1. 1
ZDS Medical Center Management Committee (ZMCMC)
The Zamboanga del Sur Medical Center Management Committee will continue to function as established for technical support and monitoring as; a. b. c. d. e. f. to formulate internal policies and guidelines for our third level hospital formulates a development plan for the next (5) five years recommend reforms towards fiscal autonomy provide technical assistance in fiscal management and audit possible technical support in development of health facility resources as infrastructures, equipment, human resources etc. develop mechanism for coordination and networking with the InterLocal Health Zones and the private health sector for a strong referral system. ZDS Medical Center Management Board (ZMCMB)
6.1. 2
Eventually, the ZMCMB (Board) shall be organized replacing the Committee. While the Committee may prove effective to respond to the challenges, there is a need to transform the body into an organization that suggests authority, permanency and continuity. 6.2 Hospital Human Resource Management & Development
Rationalize development and utilization of health human resource. Addressing the complex problem of health human resource, needs coordination of current efforts to recruit the best in the profession and augment hospital staffing in accordance to the Department of Health standards. It includes coordination with Specialty Societies, residency dispersal, consortium of hospitals in the premise for sharing of consultants and specialists and incentive for doctors, paramedical professionals and support staff. This will harmonize health human resource development in the province for equitable service capability upgrading in the true spirit of networking. 6.3 Hospital Systems and Procedures
Institutionalize financial and procurement system. Hospital fiscal and management autonomy will greatly improve hospital systems and sub-systems
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2008-2015
particularly in financial management and procurement. Improvement in the implementation of accounting, bidding procedures and sound supply management will lead to maximum utilization and prioritization of hospital resources. Procurement by consignment is ideal for our hospital. 6.4 Hospital Budget and Financial Management
Grant fiscal autonomy to our third level health facility. Financially viable government hospital can be sustained as an economic enterprise with the objective of maintaining quality service provision to its clientele not for profit, but retain its social responsibility.
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2008-2015
Chapter HEALTH FACILITY DEVELOPMENT PRIORITIES 7

Enhance health facility development. The decline in service capability effected by the devolution and some constraints in the LGUs calls for the development of a third level health facility in the province to cope with the ever increasing demand for specialized hospital services brought about the economic disparity, by an aging population and increasing life expectancy. 7.1 Rational Upgrading of Hospital Facilities & Utilities
Upgrade critical capabilities of our hospital. It includes upgrading of physical plant and provisions of additional equipment. These improvements is geared to make our hospital more responsive to the health needs of our clientele aboveall, make it more competitive and enable our hospital to effectively exercise fiscal autonomy. 7.1. 1 Construction of Physical Facilities
This will include construction the following facilities: a. b. Hospital Equipment Acquisition Project (Phase I) Comprehensive Emergency Obstetric and Newborn Care (CEmONC) Facility Project c. Hospital Transport System Improvement Project (Phase I) d. Centralized Hospital Information System Project (Phase I) e. PT-Hemo Dialysis Building Construction Project f.Watchers Utility Area Rehabilitation Project g. Doctors and Nurses Residence Inn Project h. Medical Arts Building Construction Project (Phase I) i. Communicable Diseases and Logistics Building Project j. Morgue/Autopsy Room Project k. Site and Parks Development Project (Phase I) l. Teaching Facility Project m. Motorpool and Garage Project n. Centralized Hospital Information System Project (Phase II) o. Hospital Equipment Acquisition Project (Phase II) p. Site and Parks Development Project (Phase II) q. Cardiac Diagnostic Center Project
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2008-2015
r.Perimeter Fence and Guardhouses Construction Project s. Medical Arts Building Expansion & Leasing Project (Phase II) t.Hospital Facility Maintenance Program 7.2 Human Resource Capability Building
Human resource development is integral to developing modern health facility. 7.2. 1 Training and Retooling Human Resource a. Professional Capability Upgrading Project b. Hospital Departmentalization Project 7.2. 2 Teaching and Training Capacity a. b. c. 7.3 Hospital Quality Assurance Establishment Program Medical Officers Training Program Paramedical and Staff Training Program
Hospital Financial Management Systems Installation and Upgrading 7.3. 1 7.3. 2 Installation of Automated Billing and Collection System Upgrading and Maintenance of Financial Management System
7.4
Integrating Hospital Management Information Systems (MISs)
Investment is necessary to expand networking and patient referral system between the public and private sectors in health. Hospital Information system is to be developed and linked from one facility to another. Sharing of expertise, facilities and other resources between the government and the private health professionals and facilities must be sustained.
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2008-2015
Chapter POLICY SUPPORT MEASURES NEEDED 8

8.1 Local Legislations to Support Critical Reforms 8.1. 1 Revolving Drug Fund Ordinance
A Sangguniang Panlalawigan Ordinance allowing our hospital to retain portion revolving funds to augment our decreasing (2 million MOOE budget decrease in 2006, 2007, 2008) budgetary allocation will eventually reduce our dependence to the provincial government and freeup Provincial LGU resources for other health priorities. 8.1. 2 8.1. 3 8.2 Annual Service Level Agreements (ASLAs) for the Implementation of the 5-Year Provincewide Investment Plan for Health (PIPH) for 2008-2012 Memoranda of Agreements (MOAs)
Institutionalizing Enrolment of the Poor to the National Health Insurance Program (NHIP) 8.2. 1 Social Health Insurance (SHI) Multi-Payor Scheme Ordinance
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2008-2015
Chapter HOSPITAL DEVELOPMENT INVESTMENT PROGRAM: 2008-2015 9

An effective provincial health facility system in the next decade will look quite different from the health system of today. There will be new technologies and equipment and different models of hospital care; thus, hospital infrastructure will need to be configured differently. The government (national and local) will allocate about PhP1.49 billion under the Hospital Development Investment Program (HDIP) for 2008 to 2015 as the first tranche of investment towards the goal An efficient, effective and integrated delivery system for hospital services to achieve better and equitable health outcomes. The investment will provide for redeveloping and reconfiguring the provincial health facilityand its satellite or annex unitsand establish a highly effective and efficient hospital facility network system. The entire investment, however, includes the provision of personal services (PS), Maintenance and Other Operating Expenses (MOOE) and Capital Outlay (CO) requirements. Provisions are being made for health human resource development and upgrading, health facility development and upgrading and health financing. 9.1 The Eight-Year Provincial Hospital Development Investment Program (PHDIP) 9.2. 1 Cost Summary of Investments By Component
Table 13. Cost Summary of Investments By Components

Component A. B. C. D. Health Human Resource Provision, Development & Upgrading Health Facility Development & Upgrading Health Financing TOTAL Project Cost (In PhP'000) 1,089,823 334,800 67,911 1,492,534 % to Total 73.0 22.4 4.6 100. 0
9.2. 2
Cost Summary of Investments By Year
Table 14. Cost Summary of Investments By Year of Implementation: 2008-2015

Major Component A. Health Human Resource Provision, Development & Upgrading Project Cost (In P'000)
1,089,8 23
15-Year Investment Program for CY2008-2015 [In P'000] Short-Term Medium-Term Long-Term 2008
48,98 2
2009
135,8 13
2010
133,3 15
2011
140,0 52
2012
147,1 34
2013
153,6 47
2014
161,3 78
2015
169,50
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2008-2015
B. C. D .
Health Facility Development & Upgrading Health Financing TOTAL
334,800
48,30 0 6,652
224,5 00 6,457
16,50 0 7,103
7,500
7,500
15,00 0 9,454
8,500
7,000
67,911
7,813
8,594
10,39 9 180,2 77
11,439
1,492,5 34
103,9 34
366,7 70
156,9 17
155,3 65
163,2 29
178,1 00
187,94 1
9.2. 3
Cost Summary of Investments By Source of Fund
Table 15. Cost Summary of Investments By Source of Fund

MAJOR COMPONENT Fund Source/s Project / Activity Title A. 01 02 03 04 05 B. 01 02 03 04 05 06 07 08 09 10 11 12 13 HEALTH HUMAN RESOURCE PROVISION, DEVELOPMENT & UPGRADING Professional Capability Upgrading Project Hospital Departmentalization Project Hospital Quality Assurance Establishment Program Medical Officers Training Program Paramedical and Staff Training Program HEALTH FACILITY DEVELOPMENT & UPGRADING Hospital Equipment Acquisition Project (Phase I) CEmONC Facility Project Hospital Transport System Improvement Project (Phase I) Centralized Hospital Information System Project (Phase I) PT-Hemo Dialysis Building Construction Project Watchers Utility Area Rehabilitation Project Doctors and Nurses Residence Inn Project Medical Arts Building Construction Project (Phase I) Communicable Diseases and Logistics Building Project Morgue/Autopsy Room Project Site and Parks Development Project (Phase I) Teaching Facility Project Motorpool and Garage Project EC, DOH DOH, PG-ZDS DOH/PCSO EC, DOH EC, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, USAID, EC, DOH PG-ZDS PG-ZDS, DOH USAID, EC, DOH USAID, EC, DOH Project Cost (In PhP'000)
1,089,823 6,000 1,070,161 2,287 5,958 5,417 334,800 50,000 15,000 17,000 3,300 15,000 2,500 4,000 150,000 5,000 2,500 2,000 5,000 2,000
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51

14 15 16 17 18 19 20 21 C. 01 D. Centralized Hospital Information System Project (Phase II) Hospital Equipment Acquisition Project (Phase II) Hospital Transport System Improvement Project (Phase II) Site and Parks Development Project (Phase II) Cardiac Diagnostic Center Project Perimeter Fence and Guardhouses Construction Project Medical Arts Building Expansion & Leasing Project (Phase II) Hospital Facility Maintenance Program HEALTH FINANCING Hospital Financing System Improvement Project TOTAL PG-ZDS, PHIC, C/MLGUs, BLGUs, HOR/PDAF, etc. EC, DOH EC, DOH EC, DOH PG-ZDS EC, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS
2008-2015
1,000 3,000 6,000 2,000 7,000 5,000 20,000 17,500 67,911 67,911 1,492,534
9.2. 4
Detailed Investment Program By Component By Project/Activity By Year By Source of Fund
Table 16. Detailed Investment Program By Component By Project/Activity By Year By Source of Fund
MAJOR COMPONENT Brief Description Project / Activity Title A . 0 1 HEALTH HUMAN RESOURCE DEVELOPMENT & UPGRADING Professional Capability Upgrading Project Screening, hiring and training of medical and nursing professionals to meet minimum personnel requirements for a 3rd-level health facility Departmentalization of hospital services; each department to be headed by a medical specialist. (Inclusive of PS-MOOE-CO Requirement of the whole medical center facility) Clinical cases review; grand medical rounds and peer review. Training of medical officers for residency in preferred specialization Programmed training for paramedical and support services staff PGZDS, USAID, EC, DOH PG-ZDS 20082009 Fund Source/ s Imple menta tion Year/s Project Cost (In PhP'000 ) 1,089, 823 6,000 15-Year Investment Program for CY2008-2015 [In P'000] Short-Term 200 8 48,98 2 1,00 0 200 9 135,8 13 5,0 00 2010 133,31 5 Medium-Term 201 1 140,0 52 2012 147,13 4 201 3 153,6 47 Long-Term 201 4 161,3 78 2015 169,50 2
0 2
Hospital Departmentalization Project
20082015
1,070,1 61
47,582 125,593 131,873 138,466 145,390 152,65 160,292 168,307 9
0 3 0 4 0 5
Hospital Quality Assurance Establishment Program Medical Officers Training Program
PGZDS, DOH USAID, EC, DOH USAID, EC, DOH
20082015 20102015 20102015
2,287
200
220
242
266
293
322
354
390
5,958
100
2,0 00 3,0 00
500
550
605
666
732
805
Paramedical and Staff Training Program
5,417
100
700
770
847
MAJOR COMPONENT Brief Description Project / Activity Title B. HEALTH FACILITY DEVELOPMENT & UPGRADING Hospital Equipment Acquisition Project (Phase I) Fund Source/s Implem entatio n Year/s
Projec t Cost (In P'000) 334,8 00
15-Year Investment Program for CY2008-2015 [In P'000] Short-Term 2008 48,300 2009 224,50 0 45,000 201 0 16,50 0 Medium-Term 2011 7,500 2012 7,500 2013 15,00 0 Long-Term 2014 8,500 2015 7,000
01
Procurement of additonal equipment for diagnostics and active intervention such as: (a) Ultrasound machine; (b) X-ray Machine; (c) Echo
EC, DOH
20082009
50,00 0
5,000
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Cardiography Machine; (d) Mamography Machine; and (e) Complete PT-Rehabilitation Unit Equipment Establishing a CEmONC facility.
2008-2015
02
CEmONC Facility Project
DOH
20082009 20082009 20082009
15,00 0 17,00 0 3,300
10,000
5,000
03
04
Hospital Transport System Improvement Project (Phase I) Centralized Hospital Information System Project (Phase I) PT-Hemo Dialysis Building Construction Project
Acquisition of New Ambulances and Service Vehicles Acquisition and installation of new IT hardware and software including Collection & Billing System Construction of additional 2storey building for PT-Rehab, Hemo-Dialysis, Dietary Kitchen and Private Room Facilities. Rehabilitation of existing workshop building to serve as workshop facility for watchers Construction of building facility to serve as doctors' and nurses' living quarters Construction of building facility to serve as doctors' clinics Construction of building to serve as treatment facility for cmmunicable diseases Construction of building to serve as cadaver holding and autopsy facility Landscaping works Construction of amphi theater and function hall and acquisition of shuttle bus for use by affiliates. Construction of mtorpool and garage facility. Upgrading of installed IT hardware and software Acquisition of New Hemodialysis Machines (Fresinios) Establishment of hospital shuttle services Construction of stall outlets and recreational facilities Construction of building to serve as diagnostic center; acquisition of dialysis machines, CT Scan Construction of perimeter fence and guardhouses to secure the hospital facility Expansion of building and lease arrangements. Maintenance works for all hospital structures, vehicles and equipment within the hospital compound
DOH/PCSO
2,000
15,000
EC, DOH
300
3,000
05
EC, DOH
20082009
15,00 0
5,000
10,000
06
Watchers Utility Area Rehabilitation Project Doctors and Nurses Residence Inn Project Medical Arts Building Construction Project (Phase I) Communicable Diseases and Logistics Building Project Morgue/Autopsy Room Project Site and Parks Development Project (Phase I) Teaching Facility Project
PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH PG-ZDS, DOH
20082009 20082009 20082009 20082009 20082009 20082009 20082009
2,500
500
2,000
07
4,000
2,000
2,000
08
150,0 00 5,000
20,000
130,00 0 4,000
09
1,000
10
2,500
500
2,000
11 12
2,000 5,000
1,000 1,000
1,000 4,000
13 14
15
Motorpool and Garage Project Centralized Hospital Information System Project (Phase II) Hospital Equipment Acquisition Project (Phase II) Hospital Transport System Improvement Project (Phase II) Site and Parks Development Project (Phase II) Cardiac Diagnostic Center Project
PG-ZDS, DOH EC, DOH
20092010 20102012 20102012 20102012 20102012 20102012
2,000 1,000
500
1,500 500 500
EC, DOH
3,000
3,000
16
EC, DOH
6,000
2,000
2,000
2,000
17 18
PG-ZDS EC, DOH
2,000 7,000
1,000 5,000
500 1,000
500 1,000
19
20
21
Perimeter Fence and Guardhouses Construction Project Medical Arts Building Expansion & Leasing Project (Phase II) Hospital Facility Maintenance Program
PG-ZDS, DOH PG-ZDS, DOH PG-ZDS
20102012 20132015 20082015
5,000
2,000
1,500
1,500
20,00 0 17,50 0 1,000 1,500 2,000 2,500
12,00 0 3,000
5,000
3,000
3,500
4,000
C. 01
HEALTH FINANCING Hospital Financing System Improvement Project Establishment of a Multi-Payor Scheme for social health insurance (NHIP) to contribute to universal coverage objectives; Expansion of SHI coverage and/or re-enrlment of beneficiaries PG-ZDS, PHIC, C/MLGUs, BLGUs, HOR/PDAF, etc. 20082015
67,91 1 67,91 1
6,652 6,652
6,457 6,457
7,103 7,103
7,813 7,813
8,594 8,594
9,454 9,454
10,399 10,399
11,439 11,439
D .
TOTAL
1,492, 534
103,9 34
366,77 0
156, 917
155,3 65
163,2 29
178,1 00
180,2 77
187,9 41
10/5/2011 2:26 a10/p10
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Provincial Health Facility Development Plan

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Chapter HEALTH SECTOR SITUATION IN ZAMBOANGA DEL SUR 2

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Vital Health Indicators

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Provincial Health Facility Development Plan

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Chapter PUBLIC HOSPITALS IN ZAMBOANGA DEL SUR: 3 A SITUATIONER

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Inventory of Hospital Beds and Bed-to-Population Ratios

Provincial Health Facility Development Plan

Existing Hospital Beds

About 35 additional beds are to be authorized pending issuance of license by DOH.

Aurora Labangan Mahayag Tambulig Pagadian Lakewood Dinas Margosatubig

Secondary Primary Primary Primary Secondary Primary Primary Secondary

Dumingag Molave Molave Molave Pagadian Pagadian Pagadian Pagadian Pagadian

Primary Primary Primary Secondary Primary Primary Primary Primary Secondary

Provincial Health Facility Development Plan

Tertiary Secondary Primary Secondary Primary

Pagadian Pagadian Pagadian

Tertiary Secondary Primary

Bed-to-Population Ratios (BPR)

Projected Bed Needs (PBN)

Unmet Bed Needs (UBN)

Zamboanga del Sur Province

Provincial Health Facility Development Plan

2015 1012 400 612

Occupancy Rates of Existing Hospitals

Hospital Accessibility and Strategic Location

Zamboanga del Sur Province

Provincial Health Facility Development Plan

Travel Time From Provincial Health Facility to Existing Government Hospitals

Accessibility by Usual Means of Transportation

Strategic Location In Terms of Catchment Areas