Philippines Sentrong Sigla Movement

Improving the Quality of Health Services in a Decentralized Health System:

Lessons Learned from a National Certification Program

Introduction• Definition

– SS is a quality improvement initiative through a certification/recognition program. Health facilities are certified based on a set of standards

– SS also promotes continuous quality improvement as a complementing strategy

Introduction• Steps in the Certification Process

– Philippines Department of Health (DOH) provides copies of quality standards to local government units (LGUs)

– LGU facility conducts self assessment– Mayor/Governor sends letter of intent to participate– DOH SS teams conducts assessment– LGU facility gets certified, receives SS seal– Certified facility gets monitored twice a year and

tries to strive for higher level standards

Lessons Learned

• Interest in QI is universal but a supportive environment is needed to make it happen

– Everyone likes the idea of QI– SS provided simple, practical steps to improve

quality of health services– SS provided motivation through certification

Lessons Learned

• SS became a successful model of how a national government can influence local behavior under devolution

– Getting LGUs to comply with national standards and policies: major challenge

– LGUs resent “heavy-handed approach”– SS respects local interest and priorities without

compromising standards of quality

• Political support is a critical success factor

– Applies both at the national and local level– Program should have a political value and

appeal

Lessons Learned

• Champions for quality in health care come from many sectors

– Politicians, planners, private sector representatives, community influentials championed the cause for SS

– Multisectoral interest interest and support prodded health workers to take action

Lessons Learned

• Development of standards required extensive consultations

– Consensus building through consultation– Bridging gap or balancing between technical

requirements and realities in the field: provider’s perspective and client’s perspective

Lessons Learned

• Progressive standards are needed to sustain interest in SS certification and to provide guidance to LGU facilities

– Experience with Baby Friendly Initiative– CQI interface with “static” standards

Lessons Learned

• Cash incentives maybe counterproductive

– Divert attention away from doing real quality improvement work

– Demoralize facilities not given cash incentives in spite of being certified

– Not sustainable

Lessons Learned

• Credibility of certification depends on quality of assessment

– Assessment should be accurate– Develop further skills of assessors

Lessons Learned

• Minimal involvement of private sector reduced program impact

– Enhance credibility of certification program if private sector is involved

Lessons Learned

• Link with Philippine Health Sector Reform (HSR) enhances value and sustainability of SS

– Interface with Philippines’ HSR initiatives– Adopted by Philippine Health Insurance Corporation:

SS certified facilities are eligible to be reimbursed for selected primary health care services

– Integrate with HSR

Lessons Learned