Pursuing PPP in Health in the

Philippines
Ms. Rosa Gonzales, Department of Health

The Role of Non-

Non-State Providers in Delivering
Basic Social Services for Children Regional Workshop
April 19-
19-20, 2010, ADB Headquarters

The views expressed in this presentation are the views of the author(s) and do not necessarily reflect the views or
policies of the Asian Development Bank (ADB), or its Board of Directors or the governments they represent. ADB
does not guarantee the source, originality, accuracy, completeness or reliability of any statement, information, data,
finding, interpretation, advice, opinion, or view presented, nor does it make any representation concerning the same.
 The Drivers for PPPs
• Achievement of health outcomes, rising demand
for better/improved health

• Ongoing and sustaining/complementing the gains

achieved from parallel health reforms

-2000 DOH Reengineering espousing leadership in

the health sector, shift in roles and functions

-Present reforms on health governance/financing

stress on performance and “value for money”
(eg PBGs, fiscal autonomy of health facilities and
capitation schemes)
 The Drivers for PPPs
• Initial step towards formulating a policy and
operational framework for PPPs are addressed
through Administrative Orders for key processes
and programs: 2000-
2000-2008

Examples:
- Chapter on PPP in the NOH
- Electronic Procurement System using a Private Sector Platform
- The National and Regional Coordinating Committee on Public-
Public-Private
MIX Dots
- Public-
Public-Private Collaboration in Delivery of Health Services (incldg FP,
Repro Health)
- Rapid Reduction of Maternal and Neonatal Mortality
- DOH and Dept of Labor (DOLE) Partnership: Strengthening Support
for Workplace Health Programs
 The Drivers for PPPs
• Initial step towards assessing PPPs in Health in a
more comprehensive manner was started in 2008
with assistance form the ADB Support for Health
Sector Reform, specifically, aiming to:

- benchmark Philippine experience with international

- identify and characterize PPP initiatives: strengths /weaknesses
- identify opportunities for expanding PPPs
- identify the PPP policy options for DOH

• The follow up technical assistance from ADB started in

2010 to assist DOH in formulating a policy framework
and strategic direction for PPP in Health
 PPP Types and Objectives Addressed
(Sample: 10/30 PPPs Identified)
Type Example Health
Objectives/Features
Corporate KLM: Movement Reduce malaria
Partnerships Against Malaria morbidity & moratlity
by 70% in 5 provinces
Support to Philhealth KASAPI Provide access to
Insurance Scheme health care for
members of MFIs and
cooperatives
Primary Health Care TB-DOTS (PPMD) Increase case
Services Provision (2) detection,
synchronize TB mgt
among all TB care
providers in Province
of Cavite
SAFEMOM Fill the gaps in
Maternal, FP and
Child Health in Bohol
Type Example Health
Objectives/Features
Outsourcing of Hospital La Union Medical Center Operate an economic
Services (2) and corporate enterprise
in a devolved set-up as
provided by RA 9259;
Equipments were
operated in joint venture
with private sector
National Kidney & Improve the
Transplant Center Hemodialysis Unit
applying BOT features
Interlocal Health Zones Carmen Health District Expand coverage and
Development (2) Hospital access to health services
(eg drugs through the
mini pharmacies or BnBs
New Capiz Integrated Sets policy direction for
Health Services Council mgt and implementation
of integrated health
services, generates
resources, etc.
Type Example Health
Objectives/Features
Drug Distribution Health Plus Provide access for
lower priced drugs by
the poor
Education & Training Leaders for Health Support the
educational formation
of future health
managers; develop
competencies in
changing the health
system
 SAFEMON
Program Overview: Provide quality & affordable FP Services
and upgrade the practice of midwifery (ie capacitate
midwives for entrepreneurship and Private practice.

• IMAP (Bohol) started SAFEMOM, conducted baseline study to

determine FP needs and scan existing PPPs
• Secured technical assistance from PRISM in establishing the
lying-in clinics
• Initiated training service programs for midwives (ie BEST)
• Secured Philhealth accreditation
• Secured additional funding assistance from LGU
• Systems in place: conduct of regular case conferences,
referral, MIS, communications & marketing plan
Key Achievements:
• Increase of clients by 60% and revenues
by 40-60%. Earned credit-worthy status.

• Expansion of the referral system (to capital city in the

region)

• Growth in IMAP (increased number of membership,

more benefits and increased income for midwives,
more employment, well capacitated through a
packaged training program

• Partners Benefits: Increased incomes for doctors,

and support for IEC advocacies. Provided policy
inputs in DOH and collaborated closely with LGU
in delivery FP/MCH services

• Became an advocate and rescuer for FP/MCH programs

in localities where it was least prioritized
 Lessons Learned
• Engaged/maximized partnerships for services and
resources that it could not assume well (local and
and private hospitals)

• Applied business concepts (eg socialized pricing) to

enhance operations and services)

• Contractual arrangements (MOUs) merit improvement

in terms of more specific targets and deliverables.
Other binding agreements such as penalties for
non-compliance were not included
 STRENGTHS of PPPs
• Offers richness of experience because of diverse
types and forms

• Partnership can be tripartite or more

(eg with the corporatized ILHZ & emphasis on
people or community responsibility)

• Some have been scaled-

scaled-up with new funding
because of encouraging results
(eg SAFEMOM, KLM: Movement Against Malaria)

• Support systems (eg IT) improved operations

(eg LUMC)
 WEAKNESSES of PPPs

• Informality of governance structures: absence of

long-
long-term planning, weak contractual arrangements
and accountability

• Relies heavily on charismatic leadership rather than

putting premium on strengthening of institutional
structures

• Relies on foreign donors for funding

• Can duplicate in some instances because objectives

are not well integrated into the broader health
system
 The Challenges for DOH

• As leaders or overseers: capacity for contract

management, monitoring and evaluation

• Institutionalizing the PPP Unit in DOH with an

overstretched staff and undersized DOH: In doing
ME, should we contract PPP monitor solely for this?

• Developing a policy framework with more and

sound evidence. Hence, a PPP Research Agenda?

• Access to vital resource on PPP documentation and

institutionalizing these in the policy process of
DOH that PPP concerns/updates are reported in
the Execom