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INTEGRATIVE PAPER

Areas of Study Where are we now? Where do we want to go?

Strategy:
What is our Lack of strategy.
strategy? No clear objectives.
How do we intend Apathetic to competitive
to achieve our pressure. Works just to
objectives? get by.
How do we deal Patient demands are not
with competitive given much importance.
pressure? No clear strategy to
How are changes in address environmental
customer demands issues.
dealt with? Supplies run out quickly
How is strategy due to lack of strategy to
adjusted for address the demands of
environmental patients due to deep-
issues? rooted dole-out mentality
(non-indigents also
depend on dole-outs)
worsened by political
leverage.
Structure:
How is the Staff is divided into two
organization/team factions resulting from
divided? issues concerning politics
What is the and previous
hierarchy? disagreement on alleged
How do the various corrupt practices.
departments All power is
coordinate
activities?
How does the team
member s organize Activities are coordinated
and align between departments
themselves? within the same faction. If
Is decision making coordination cannot be
and controlling avoided, communication
centralized or is directed through
decentralized? Is neutral channels.
this as it should be, Decision-making is
given what were centralized to whoever is
doing? the OIC with decisions
Where are the lines made with minimal or no
of communication? input with the other staff.
Explicit and No direct communication
implicit? between the NO and OIC.

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 Minimal or indirect
communication between
the SO and OIC.
Systems:
What are the main Currently all financial and
systems that run HR systems are run by
the organization? the LGU. Purchase of
Consider financial meds from suppliers are
and HR systems as not handled by the RHU
well as and so medicines are
communications sometimes not purchased
and document properly (ie, wrong
storage. amount, not all meds
Where are the from submitted list are
controls and how purchased, etc.)
are they monitored Computer system not
and evaluated? sufficient to keep up with
What internal rules modernization.
and processes does Inefficient system to
the team use to measure productivity and
keep on track? enforce accountability.
A monthly staff meeting is
regularly conducted to
discuss important issues
and concerns, upcoming
activities, and monthly
schedules.
Shared Values:
What are the core Some of the staff are not
values? service/people-oriented.
What is the Some of the staff are not
corporate/team motivated to improve
culture? their performance.
How strong are the There is a gap between
values? some of the organic staff
What are the and the DOH hired staff
fundamental values (ie, NDPs and RHMPPs)
that the where the organic staff
company/team was treats the DOH hired staff
built on? as inferior to them. This
gap may have been
precipitated by the higher
salary received by the
DOH hired staff prompting
some of the organic staff
to heap most of the work
to them and other
concerns on paper works
and reports.
Casual employees are not
motivated to work
especially during night
 and weekends because of
lack of compensation for
these times. Problems
arise when the staff-on-
duty who are mostly
females require the
assistance of male
casuals who do not go on
assigned duties.
Style:
How participative is Laissez-faire transitioning
the to democratic.
management/leade Laissez-faire not much
rship style? effective as the staff have
How effective is become complacent.
that leadership? Democratic more
Do effective but decision-
employees/team making is generally
members tend to slower and sometimes
be competitive or decisions are biased due
cooperative? to the majority of one
Are there real group banding together to
teams functioning affect major decisions (ie,
within the greater number of
organization or are midwives).
they just nominal Staff tend to be generally
groups? cooperative to the MHO
but less to a certain
degree with other groups
(ie, organic staff and
DOH-hired staff).
Each barangay has an
RHM and NDP tandem.
Each group works
together to complete
tasks assigned to them
(they are functional so
far) but there are
problems on how they
treat each other due to
problems/gaps mentioned
earlier.
Staff:
What positions or There are the obvious
specializations are specializations of the MHO
represented within who heads the clinic, the
the team? PHN-II in charge of the TB
What positions Program, the PopCom,
need to be filled? and Philhealth, the PHN-I
Are there gaps in who consolidates all data
required (handles FHSIS) and
competencies? reports the consolidated
 data to the MHO, the
Medical Technologist who
handles all laboratory
procedures (includes
DSSM), the RSI who
handles the Sanitation
Office and reports directly
to the MHO, the NO who
handles the Nutrition
Office and reports directly
to the MHO, the RHMs in
charge of their own BHS
(present in all barangays)
and also handles different
DOH Programs, the NDPs
which serve in an
auxiliary capacity to the
RHMs in implementing the
different DOH programs
and activities as well as
head the barangay CHTs,
the RHMPP which also
serves in an auxiliary
capacity to the RHM in
terms of deliveries and
other technical work, the
Admin Aide which serves
as the clerk for the clinic,
handling records and
temporarily serving as
ITIS (Integrated
Tuberculosis Information
System) encoder, the
ambulance driver, and the
casuals.
Some program holders
are not efficient in
managing their assigned
programs.
Retraining of staff on IMCI
and BEMONC as well as
additional competencies
such as BLS, and
additional training are
required for them to be
more effective. Also
healthcare customer
service training is needed
to earn rapport with the
people of the community
which is especially
important in increasing
 facility based
deliveries/SBA deliveries.
MHOs rarely hold the
position for more than a
few years and so hadnt
had the time to fully
implement strategies and
innovations.
Skills:
What are the All staff have the basic
strongest skills competency for their job
represented within and is able to handle
the basic clinical problems
company/team? and reporting.
Are there any skills Though competent a skills
gaps? and knowledge retraining
What is the and update is necessary
company/team to improve their
known for doing performance. It is our
well? hope that a CHITS system
Do the current be provided to improve
employees/team overall efficiency of the
members have the staff but a skills update
ability to do the would be necessary and
job? some of the more
How are skills senior staff are having
monitored and difficulty in using
assessed? technology such as
laptops/computers.
Some skills are
underutilized due to
restrictions placed such
as the NO being a
registered nurse but is not
allowed to perform the
skills of his profession.

STAKEHOLDERS ANALYSIS

Stakeholder Roles Interests Issues/Concerns Action Desired

EXTERNAL
Department of Provide Achievement Delays and Improve coordination and
Health technical of targets for problems in partnership with the LGU
assistance to health implementing its
 health indicators programs to the Amount and type of
programs municipality supplies given should be
Attainment of based on actual need
Supplement targets for Some programs based on RHU data
medical health-related not coordinated or
supplies and SDGs with no input from
equipment the LGU thereby
Healthcare for downloading
Conduct of all/Universal programs not
trainings and Health care suited for the
updates Municipality

Some supplies
given too few or
too many in
quantity
Inter-local Partner in Development
Health Zone implementatio of the health
n of joint system of the
health four
programs municipalities
in Ticao Island
(Monreal, San
Jacinto, San
Fernando,
Batuan)
Municipal
Social Welfare
and
Development
Other
municipal
departments
NGO/CSO
Religious
Sector
Department of
Education
INTERNAL
Rural Health Main health Implementatio Inadequate Proper planning and
Unit Staff service n of health equipment and implementation of health
provider programs supplies programs

In charge of Achieve Lack of IT staff Provision of additional IT

health national staff to handle new trends
promotion target for Reaching far flung in modernization of health
and education health barangays care system
indicators
Insurgent threat Improved capacity of BHS
esp. on GIDA to provide basic medical
barangays services and readily
available transportation in
 emergency cases

Proper scheduling and

logistics planning to
maximize efficiency of
barangay visits

Dialogue which
Municipal Local Chief Gain support Political rivals Increased support for
Mayor Executive of the people health programs
More visible
General Attain target programs/projects Increased awareness on
supervision indicators for the importance of health
and control good Limited budget as a multifactorial
over all governance leverage
activities of
the municipal Accomplish Bridge the gap between
or city administration different stakeholders
government s objectives
and projects
Chairman of
the local
health board
Sangguniang Members of Support of the More visible Creation of resolutions
Bayan the LHB people programs/projects and ordinances related to
health
Passes
resolutions
and
ordinances

Legislative
branch of the
municipality
Barangay Implementing Accomplishme More visible Promote and support
Officials body at the nt of programs/projects health programs
barangay objectives and
level projects in the Limited budget Allot budget for medicines
barangay and supplies to their
Political rivals respective BHS
Support of the
people Provide transportation
services in emergency
cases esp. those in GIDA
areas

Provide support to their

health workers
Barangay Implement Accomplish Lack of medical Properly fulfill their duties
Health and promote duties and equipment for use and functions
Workers/Baran health functions
gay Nutrition programs at Subject to political Participate in capacity
Scholars the barangay Improvement appointment/dism building trainings and
level of knowledge issal activities
and skills

Support of the
barangay
officials and
constituents

PROBLEM TREE ANALYSIS