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ANNUAL OPERATIONAL PLAN PROVINCE OF CAVITE (2012) I. GENERAL DESCRIPTION: A. BRIEF DEMOGRAPHIC PROFILE OF THE PROVINCE: One of the fastest growing provinces in the country today, Cavite is a first class industrializing province making up the CALABARZON area together with the provinces of Batangas, Laguna, Quezon and Rizal. The province lies along the southeastern coast of Manila Bay and is bounded by Metro Manila on the northeast, by the province of Laguna on the east and by the province of Batangas on the south (Fig. 1.).Cavite has a total land area of more or less one thousand four hundred twenty seven square kilometers (1,427.06) with a total population of three million four hundred thirty two thousand nine hundred (3, 432,900); or a population density of two thousand four hundred six persons per square kilometer (2,406 persons /km). Owing to a heavy influx of inmigration of jobseekers from nearby provinces, the province has at present a high population growth rate of around five and four hundred percent (5.4o%).

Health Resource Analysis

Fig. 1. Map of Cavite showing 7 political districts Previously, the province is composed of only three (3) cities and twenty municipalities in three (3) political districts but lately however, it has been divided into seven political districts and one of its municipalities (Dasmarinas) has turned into a city; altering the provinces composition into nineteen (19) municipalities and four (4) cities (Table 1.). Of the four cities, one has been classified as a first class city, two of them belong to the third class category while another one falls on the fourth class category.

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On the part of the municipalities, four (4) are categorized as fifth class, (6) as fourth class while the remaining nine belong to the second to first class categories. In addition to the aforementioned political districts, the province has also been subdivided into five (5) Inter Local Health Zones (ILHZ) for health services delivery purposes. The subdivision for the Inter Local Health Zones did not necessarily follow the pattern for that of the political districts but rather considered or took into account the proximities of the member municipalities or cities to a higher level health facility. This is the reason why the municipalities of Imus and Bacoor are members of the Las Pinas ILHZ of the National Capital Region. (Table 2.). The City of Tagaytay has not joined any Inter Local Health Zone (Fig. 2.). Table 1. Political Districts of Cavite (as of 2009), N=7 Districts District 1 District 2 District 3 District 4 District 5 District 6 District 7 Municipalities / Cities Municipalities of Kawit, Noveleta, Rosario and City of Cavite Municipality of Bacoor Municipality of Imus City of Dasmarias Municipalities of Carmona, GMA, Silang Municipalities of Amadeo, Gen. Trias, Tanza and City of Trece Martires Municipalities of Alfonso, General Aguinaldo, Indang, Magallanes, Maragondon, Mendez, Naic, Ternate and City of Tagaytay

Table 2: Interlocal Health Zone, Distribution of Cities / Municipalities N=6 ILHZ AMIGA GenTaMar MagNaMarTe RosCaNovKa SiGmaCarDas
Las Pias ILHZ

Municipalities / Cities Amadeo, Mendez, Indang, Gen. Aguinaldo, Alfonso Gen. Trias, Tanza, Trece Martires City Magallaes, Naic, Maragodon, Ternate Rosario, Cavite City, Noveleta, Kawit Silang, Gen. Mariano Alvarez, Carmona Dasmarias City Imus Bacoor

Legend:
RosCaNovKa GenT aMar SiGm aCarDas A MIGA MagNaMarT e
R osario Im us K it aw N eleta ov B or aco C ite city av

T anza

G T en. rias Dasm arias G A M

N aic T rece M artires C ity C ona arm

T ernate

M gondon ara S ilang Am adeo G en. Aguinaldo M agallanes Indan g

The m unicipalities of Im & Bacoor us are included in the ILHZ of Las Pias T agaytay City is not included in any ILHZ

M endez A lfonso T agaytay City

Fig. 2. Map showing the five Inter Local Health Zones (ILHZ) of Cavite.

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Health care services all over the province are jointly provided by the public and private health facilities. As of 2010, Cavite has thirteen government owned hospitals of which one (1) is in a Level IV category; another one is categorized as Level III; two as Level II; while all the remaining nine (9) except for one specialized hospital (mental) are of the Level I category. On the other hand, there are forty one (41) private hospitals operating in the province, of which two (2) are Level IV, seven (7) are Level III, twenty two (22) are Level II and ten (10) are Level I. To provide public health services at the grass roots level, the province has likewise thirty five (35) Rural Health Units and City Health Offices (RHUs and CHOs) as well as five hundred eighty nine (589) Barangay Health Stations (BHSs). Although all thirteen (13) government owned hospitals are PhilHealth accredited, only thirty five (35) of the forty one (41) private hospitals are accredited. In a likewise manner, only fourteen (14) and nine (9) Rural Health Units out of 35 RHUs are accredited to provide OPB and DOTS health services packages respectively. No RHU is accredited to provide MCPs (Table 3.).
Health Facilities
Total Number No. and % of PhilHealth Accredited LGU Hospitals No. and % of PhilHealth Accredited Private Hospitals No. and % of OPB Accredited No. and % of MCP Accredited No. and % of DOTS Accredited

Public hospitals Private Hospitals Total Rural Health Units (RHUs) Barangay Health Stations (BHS)

13 41 53 35 589 13 (100%) 35 (85.36%) 14 (40%) 0% 9 (25.71%)

Table 3. Status of Health Facilities, Province of Cavite, 2009 Manning the above mentioned Public Health facilities are a handful of public health manpower struggling tirelessly to provide frontline health services within their respective localities in the province. Although, some improvements have been gained for the past couple of years in increasing the number of public health personnel in the Rural Health Units, almost all public health services with regards to personnel key providers are outnumbered in terms of the ratio of manpower to the number of populations to be served as shown in Table 4. Moreover, the table only shows the average ratio for the whole province, so that in the more urbanized localities of the province the ratios are in fact even lower; which admittedly affect efficiency and effectiveness in providing public health services delivery in such localities. Health Provider Doctors Nurses Midwives Dentists Medical Technologists Sanitary Inspectors Nutrition Officer (N.O.) Number 45 145 334 55 32 74 8 Ratio / 100,000 Population 1:64,744 1:20,093 1:8,723 1:52,973 1:82,923 1:39,372 Only 9 N.O.* for 19 Municipalities and 4 cities Ideal Ratio / 100,000 Population 1:20,000 1:20,000 1:5,000 1:50,000 1:20,000 1:20,000 1 N.O. per municipality

Table 4: Profile of Public Health Care Providers, Province of Cavite (2011)

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B. THE GENERAL HEALTH SITUATION OF THE PROVINCE AT THE END OF 2010: B.1. Assessment of the province based on the Province-wide Health System of the LGU SCORECARD: A comparative review of both of the 2009 and 2010 Province-wide LGU SCORECARD SUMMARY OF ACCOMPLISHMENT (Table 5 and Table 6 below) coupled with that of the Vital Health Indices of Cavite for 2009 and 2010 suggests that the general health status of the province has not improved much from that of 2009. Notably, the province has not performed quite well in the areas of Service Delivery and Financing in 2010 compared to that of 2009. While only one (1) performance indicator under Service Delivery has shown a negative accomplishment in 2009, nine (9) indicators have in 2010. The same is true for indicators under Financing. The provinces performance with respect to these indicators has not changed; three (3) out of five (5) indicators still have negative accomplishments. LGU Scorecard Priority Program Thrusts (By Pillar) Service Delivery Regulations Financing Governance TOTAL No. of Performance Indicators 17 1 5 5 28 With Positive Accomplishment 8 1 2 4 15 With Negative Accomplishment 9 O 3 1 13

Table 5: LGU Scorecard Summary of Accomplishments Per Performance Indicator (2010) LGU Scorecard Priority Program Thrusts (By Pillar) Service Delivery Regulations Financing Governance TOTAL No. of Performance Indicators 16 2 5 5 28 With Positive Accomplishment 15 2 2 5 24 With Negative Accomplishment 1 0 3 0 4

Table 6: LGU Scorecard Summary of Accomplishment Per Performance Indicator (2009). A more detailed study of the Province-wide LGU SCORECARD for 2010 will reveal that although the Ave. PWHS for the prevalence and incidence rates of Leprosy and Rabies respectively are far lower than the 2010 NOH targets, both has gone up slightly in 2010 which might require a little bit of attention. The same is also true for TB Cure Rate, as well as the percentage of Fully Immunized Children and Contraceptive Prevalence Rate. All three have also shown negative accomplishments.

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With respect to the capability improvement of the provinces health facilities; which in one way or another is reflected on the average length of stay of patients in the hospitals; in the average occupancy rate, also in the average hospital gross deaths from maternal causes, including BEMONC to population ratio and the percentage of Rural Health Units accredited by PhilHealth for outpatient packages benefits (particularly OPB and MCP); the province has not fared any better. All the above indicators have likewise shown negative accomplishments. Not to be over looked however, is the performance of the province in the area of Health Financing. Note that the percentage of poor families enrolled in the NHIP has gone down from forty two percent (42%) in 2009 to only 20.43% in 2010. Similarly, the percentages of Provincial and Municipal Budgets allocated to health have decreased from twenty five percent (25%) and eight percent (8%) respectively in 2009; to twenty two percent (22%) and six percent (6%) in 2010. Admittedly, more often than not, factors governing and or affecting the increase in percentages of these indicators are beyond the control of the health program managers at the provincial level who are tasked to pursue these thrusts. In one way or another, the negative accomplishments shown by these indicators might have indirectly affected the implementation of the activities under Service Delivery; contributing somehow to a poorer performance during the previous year. Consequently, the poorer performance of the province in implementing the activities under Service Delivery might have led to the rising of the rates of the provinces Vital Health Indices as seen in the accompanying table (Table 7). For instance, the rise in maternal deaths (MMR) might be partly attributed to the inadequacy of BEMONC and CEMONC facilities throughout the province aside from other contributing factors. 2009 Infant Mortality Rate (IMR) Maternal Mortality Rate (MMR) Crude Death Rate (CDR) Crude Birth Rate (CBR) 5.33 41.02 3.59 21.75 2010 6.65 61.29 3.74 20.16

Table 7: Vital Health Indices, Cavite Province, 2009-2010 Apart from the previously mentioned indicators however, most of the other remaining ones under Service Delivery have shown satisfactory results including most of those under Regulation and Governance. As can be noted from the scorecard, although the provinces TB Cure Rate decreased by one percent from 75% to 74%; TB Case Detection Rate on the other hand has increased from 34.5% to 60.81%. The same could also be said for the indicators of programs in malnutrition, breastfeeding, sanitation, facility based deliveries, and several others more. The province has likewise managed to make some head ways in decreasing the average manpower to population ratio among its Rural Health Units particularly for the Rural Health Physicians and Midwives. It has also reduced further the ratio of BNB to barangays served from 1 is to 5.591 to 1 is to 3.30. Over all, despite having more indicators with negative results, the implementation of the AOP 2010 has managed to sustain the health developments gained by the province for the past several years and maintained its general health status as that of the preceeding year ( 2009 ); as evidenced by the Top Ten Leading Causes of Morbidity and Mortality. (Table 8,9 and Table 11). Note that the top ten leading causes of diseases and deaths for 2009 and 2010 do not differ much form each other. In short and speaking generally, the causes of morbidity in both years were more by infectious diseases while that of mortality were by degenerative and lifestyle diseases.

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Diseases

Number

Rate

1. Hypertension, HPN 2. Acute Upper Respiratory Infection, Unspecified 3. UTI, site not specified 4. Influenza, virus not specified 5. Non-infective gastroenteritis & colitis, unspecified 6. Other specified respiratory disorders 7. Multiple open wounds, unspecified 8. Acute Nasopharyngitis 9. Bronchitis, not specified as acute or chronic 10. Disorder of the skin & subcutaneous tissue

124, 056 71,820 10,982 6,508 6,480 5,580 5,473 4,162 3,872 3,618

4,257.97 2,465.08 376.94 223.37 222.41 191.52 187.85 142.85 132.9 124.18

Table 8: Leading Causes of Morbidity, 2010 Cavite Province, Rate per 100,000 pop. Diseases 1. Acute Upper Respiratory 2. Hypertension 3. Diarrhea 4. Influenza 5. Bronchitis 6. Pneumonias 7. Urinary Tract Infection 8. Wounds 9. Acute Tonsilo-pharyngitis 10. TB Respiratory Number 18,664 10,293 8,422 5,363 5,305 5,107 2,466 1,815 1,631 1,304 Rate 723.89 399.22 326.65 208.00 205.76 198.10 95.64 70.39 63.26 50.58

Table 9: Leading Causes of Morbidity All Ages: Cavite Province, 2009, Rate Per 100,000 Pop. Diseases 1. Pneumonia, unspecified 2. Acute Mycocardial Infection 3. Malignant neoplasm without specification 4. Hypertensive heart disease 5. Heart Disease, organic, unspecified 6. Cardiovascular disease, unspecified 7. Acute Renal Failure 8. Respiratory Tuberculosis 9. Unspecified Diabetes Mellitus 10. Atherosclerotic heath disease Number 751 746 584 515 455 407 371 330 329 283 Rate 25.78 25.6 20.04 17.68 15.62 13.97 12.73 11.33 11.29 9.71

Table 10: Leading Causes of Mortality, 2010, Cavite Province, Rater per 100,000 pop.

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Diseases 1. Cancer 2. Pneumonia 3. Heart Disease 4. Acute Myocardial Infraction 5. Hypertensive Vascular Disease 6. Diabetes Mellitus 7. Renal Failure 8. Tuberculosis 9. Degenerative Diseases 10. Cerebrovascular Accident

Number 819 743 717 633 592 388 352 326 291 276

Rate 31.77 28.82 27.81 24.55 22.96 15.05 13.65 12.64 11.29 11.00

Table 11: Leading Causes of Mortality, 2009, Cavite Province, Rate per 100,000 pop.
II.

THE LOCAL HEALTH PRIORITIES FOR 2012: In setting up the local health priorities for 2012, the Province-wide Investment Plan for Health (PIPH) was again reviewed and re-assessed together with that of the Annual Operational Plan for 2011 (AOP 2011). The results from the analytical review and re-assessment of the two documents including those from the evaluation of the LGU SCORECARD for 2010 have served as the bases as well as the guidelines in re-adjusting the planned local health priorities for 2012 as contained in the PIPH in order for them to be more responsive to the provinces current general health situation. Care have been also taken to ensure that these priorities are linked with the major thrusts of the National Government and the CHD in support of attaining the National Objectives for Health, the MDGs and the goals and objectives of Universal Health Care (UHC). Emerging health problems and lifestyle related diseases were likewise identified by going over the Internal and External benchmarks of the LGU SCORECARD; while programs and activities from the AOP 2011 which the province has not been able to implement were also considered and included for implementation in 2012. Emerging from all the preceeding considerations are the general key areas from which the provinces local health priorities were strategically focused; in consonance with the six (6) strategic instruments of Universal Health Care. In summary therefore, the local health priorities of the province are broadly outlined as follows: 1. Health Financing: a. Expansion of NHIP Enrollment: To improve financial risk protection of its poor and most deserving constituents, the Provincial Government has allotted Php 11,225,000.00 for enrolling the poor and indigents in the NHIP of the National Government. In addition to this, MLGUs and other partner agencies are also very supportive of the PhilHealth Sabado Program.
b. There is also a need to intensify advocacy to increase the accreditation of health

facilities in the province for TB and PTB especially MCP packages to address the increasing demand for these services as a result of increasing enrollment.
c. MLGUs has adopted the National Household Targeting System (NHTS) in enrolling

indigents despite some issues and concerns in the manner / system of listing indigents.

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2.

Service Delivery: a. Improvement in the delivery of quality health services through: a.1. Health Facilities Enhancement: establishment of BEMONC and CEMONC facilities upgrading / renovation of existing health facilities. provision of equipments. establishment of new health facilities. Training of BEMONC teams in the following five (5) priority areas: (Dasmarias, Indang, Amadeo, Gen. Trias and Tanza.) Establishment of functional Womens Health Teams (WHT) delivery network once a referral system is formulated. b. Attainment of MDGs: b.1. Increased rates in: TB CDR TB CR b.2. Decreased Rates in: Maternal death thru increased facility based deliveries IMR CDR b.3. Increased rates in FIC CPR Skilled Birth Attendants c. Emerging Health Problem: Dengue Prevention and Control Program HIV-STI d. Lifestyle Related Health Problems: Diabetis Cancer Smoking
e. Public-Private Partnership Enhancement:

e.1. Strengthening partnership with PRISM for technical assistance in developing Family Planning (FP) and Maternal and Child Health (MCH) PROGRAMS:

CSR Plan CBMIS Referral System Enhancement of FH Programs in Workplaces Inclusion of Private Health Facilities in Service Delivery Network. Reporting of Accomplishments (CPR,SBA,FBD)

f. Implementation of unimplemented AOP 2011 planned programs and activities.

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3. Policy, Standards and Regulation: a. Formulate and adopt policies to ensure health services accessibility to all, particularly the poor and the indigents; and the attainment of MDGs. b. Conduct advocacy for Facility Based Deliveries (FBD) and Newborn Screening. c. Ensure availability of low cost essential drugs and medicines through BNBs. d. Public Private Partnerships in TB-DOTS program, Voluntary Blood Donation program e. Intensify the enforcement / implementation of Environmental Sanitation Rules and Regulations. 4. Governance for Health: a. Improve efficiency in the provision of health services by increasing bed occupancy rate; decreasing the average length of patients stay in hospital facilities. b. Promote transparency in all health related transactions. 5. Human Resources for Health: a. Provision of additional manpower as per the Rationalization Plan of the province (RAT PLAN). b. Provision of Magnacarta Benefits to all health workers. 6. Health Information: a. Implementation of e-FHIS, PIDSR, SPEED, in health emergencies. b. Provide IT equipments to HF (HOMIS for Hospitals). c. Provide adequate funds for IT services.
III. THE MAJOR THRUSTS OF THE AOP 2012:

The less than satisfactory performance of the province in several health program indicators as portrayed by the External Benchmarks in the 2010 LGU SCORECARD has exerted much influence in the formulation of the AOP 2012 strategic thrusts. As can be noted from the Scorecard, the province has still a low percentage in the number of poor families enrolled in NHIP. In the prevention and control of communicable diseases, there is still much room for improvement as evidenced by the top ten leading causes of mortality where respiratory tuberculosis still ranks number eight. Similarly, TB Case Detection and TB Cure rates are still way below the 2010 NOH targets. It could likewise be noted from the Vital Health Indices of the province that both the IMR and the MMR have gone up considerably for the past two years compared with those of 2007; while the average bed occupancy rate of its lower level hospitals remain quite below the average 2010 NOH target. The poor showing of these indicators evidently requires more committed attention in the areas of health facilities improvement, health care financing and in the efficiency, effectivity and responsiveness of health services delivery. In an effort therefore to further improve the performance of the province in the above mentioned areas of concerns while sustaining the health reforms and improvements it has gained so far; as well as in keeping attuned to the goals and objectives of Universal Health Care; the AOP 2012 has focused its implementation agenda in pursuing the following general strategic thrusts:

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1.

Financial Protection Through Expansion in NHIP Enrollment and Benefit Delivery:

Increase the percentage in the number of poor families enrolled in NHIP

through advocacy and coordination with partner agencies and organizations including informal sectors. Adoption of NHTS in identifying indigent families Increase the number of Philhealth accredited facilities for TB-DOTS, MCP and OPB healthcare packages. Increase LGU investments for health to at least 15%. Source out endowment funds for indigent patients. Establishment of Local Health Accounts using 2011 data.

2. Improved Access to Quality Hospitals and Other Health Care Facilities:

Rationalization of Local Health Facilities to include establishment of BEMONC facilities in some satellite hospitals, rural health units, lying-ins and barangay health stations. Upgrade a municipal hospital and six (6) satellite hospitals Construction of new additional twenty five (25) bed and fifty (50) bed capacity hospitals. Strengthen public-private partnerships for the formulation or establishment of financial mechanisms to support health facility enhancement programs and projects. Improvement of government owned health facilities through income retention. Enforcement of National Health Legislations and other health related Policies and Standards. Ensuring the availability and access to low-cost quality essential drugs and medicines and other health commodities particularly to the poor and the indigents who needs them the most. Strengthening the Local Health System development and improve referral network system to address fragmentation of health services within a particular inter-local health zone. trengthening Local Human Resource Management System to improve the frontline health manpower to population served ratio in all public health facilities of the province. Institutionalization of monitoring and evaluation of health reforms to track down and evaluate implementation of health programs, projects and activities and indentify and address issues and concerns affecting each program or activity. Strengthening Health Information System and data gathering. 3. Attainment of Health Related MDGs: Sustaining the efforts on establishing disease free zones such as malaria, rabies and leprosy. Intensifying efforts on prevention and control of both communicable and noncommunicable diseases including emerging and re emerging health problems to reduce morbidity and mortality and the prevalence of emerging diseases such as HIV/AIDS. Improvement of Reproductive Health Outcomes to reduce maternal and child mortality.

Intensifying Healthy Lifestyle and Management of Health Risks to reduce the prevalence of lifestyle related diseases including degenerative diseases. Intensifying enforcement of Environmental Sanitation rules, regulations, standards and policies. Strengthening Disease Surveillance and Epidemic Management System. Strengthening Disaster Preparedness and Response System.

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IV.

PERFORMANCE INDICATORS FOR THE AOP 2012: The performance of the province in the implementation of the AOP 2012 shall be gauged in general by monitoring the progress made upon the institution of its programmed measures and interventions based on the following indicators: A. Public Health Service Delivery: a.1. Increased percentage in the number of poor and indigent families enrolled in NHIP. a.2. Improvement on the provinces vital health indices such as decreased IMR, MMR, CDR and CBR. a.3. Decreased incidence rates of communicable and non-communicable diseases. a.4. Decreased prevalence of lifestyle related and degenerative diseases including emerging health problems (HIV/ AIDS). a.5. Increased percentage of Fully Immunized Children including newborns initiated to breastfeeding. a.6. Reduced prevalence of malnutrition and common childrens illnesses among under five children. a.7. Increased or sustained percentage in the number of households with access to safe drinking water and basic sanitation facilities. a.8. Improved availability and accessibility of low-cost essential drugs, medicines and other health commodities to the poor and the indigents. a.9. Improved health information system and referral network. a.10. Increased percentage of Local Health Budgets allocated to Health. a.11. Strengthened disease surveillance and epidemic management system. B. Hospital Services b.1. Improved quality of service resulting to a decreased average length of patients stay in hospital facilities. b.2. Increased Bed Occupancy Rates of Lower Level Hospital facilities in the province. b.3. Upgraded and expanded hospital capacities and capabilities to be responsive to traumatic injuries and other health emergencies. b.4. Strengthened hospital facilities and manpower in disaster preparedness and response system.

V. AOP 2012 Matrix of Activities

VI. Supplemental Plans:

a. Annual Training Plan b. Project Procurement Plan c. Financial Plan VII. Appendices: a. LGU SCORECARD (2010).