Procurement System in the Philippines

Teodoro J. Herbosa MD FPCS College of Medicine & National Telehealth Center

University of the Philippines, Manila Former Undersecretary of Health

Republic of the Philippines

Outline• Background information: Philippines

• Philippine Health System

• Government Procurement System

• Procurement of Medicines

• Health Financing

• Public Private Partnership

• Case discussion

Republic of the Philippines

Southeast AsiaArchipelago 7,107 islands

100million peopleDemocracy

Low Middle Income Colonized by Spain, USA

and Japan

Statistical FiguresPopulation (May 2010) 92.34MPopulation (Aug 2007) 88.55M

Inflation Rate (Jun 2015) 1.2 %Total Exports(Apr 2015) $4.38Bp

Total Imports (May 2015) $4.39BpBalance of Trade (May 2015)

$508.86MEmployment Rate (Apr 2015)

93.6%pUnemployment Rate (Apr 2015)

6.4%pUnderemployment Rate (Apr 2015)

17.8%pLFPR (Apr 2015) 64.6%p

Simple Literacy (2000) 92.3%Functional Literacy (2008) 86.4%

Average Family Income(2012)

Health System• "Two" health systems

• Private healthcare vs Public healthcare = health inequity

• Centralized to Decentralized

• Infrastructure gap hospital bed to pop is 5/10,000

• Rapid population growth

• Increasing health costs

• Health Indices and Statistics

• Total population (2013) 98,394,000

• Gross national income per capita (PPP international $, 2013) 7

• Life expectancy at birth m/f (years, 2013) 65/72

• Probability of dying under five (per 1 000 live births, 0) not available

• Probability of dying between 15 and 60 years m/f (per 1 000 population, 2013) 255/136

• Total expenditure on health per capita (Intl $, 2013) 287

• Total expenditure on health as % of GDP (2013) 4.4

• Latest data available from the Global Health Observatory

Health Reforms• Primary Health Care "Alma Ata"

• Corporate government hospitals

• Generics Law

• Decentralization (devolution) Local Government Code

• National Health Insurance Act

• Health Reform Agenda

• Universal Health Care (Sin Tax Financing)

Government Procurement • RA 9184

• Post qualification methodology

• Head of Procuring Entity (HOPE)

• Bids and Awards Committee (BAC)

• Technical Working Group (TWG)

• Recommendation to Award (RTA)

• Notice of Award (NOA)

• Purchase Order (PO) or Contract

Corruption• Collusion

• Price manipulation; overpricing

• Kickbacks

• Insider information

• Fake qualification documents

• Variability of costs

Procurement of Medicines• Programs ("vertical") TB, vaccines, leprosy,

• Vaccines (EPI) Expanded Program of Immunization

• TB (NTP) National Tuberculosis Program

• Leprosy (NLP) National Leprosy Program

• Others

• What is Medicines Access Programs (MAPs)• Types of MAPs

• MAPs for out-patient care:

• Botika ng Barangay (BnB)

• DOH Complete Treatment Pack (DOH ComPack)

• MAPs for in-patient care:

• Regular in-patient care

• Catastrophic Care

• Acute Lymphocytic Leukemia Medicines Access Program

• Breast Cancer Medicines Access Program

• Rare Disease Medicines Access Program

• Other MAPs

• DOH Insulin Access Program

• Valsartan Access Program

• Geriatric Health Care Medicines Access Program

• Mental Health Care Medicines Access Program

• Universal Health Care (UHC) and Access to Medicines

• Universal Health Care (UHC) is the call and commitment of the Philippine Government to ensure that every Filipino has access to quality and affordable health care.

• In 2011, the Department of Health announced its goal to achieve UHC under the flagship program of President Benigno Aquino III known as Kalusugan Pangkalahatan (KP) focusing on improving access to health care services and reducing poverty from catastrophic healthcare expenditures especially for the poor and most vulnerable population.

• Universal Health Care (UHC) and Access to Medicines

• .To achieve Universal Health Care (UHC), or Kalusugan Pangkalahatan (KP), is defined as the "provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitability distributed, adequately funded, fairly financed, and a appropriately used by an informed and empowered public". The administration puts it on top of the socioeconomic agenda to improve the health and quality of life.

• To attain UHC, the DOH defined three strategic thrusts to be pursued from 2011-2016, namely:

• 1) Achieve the health-related Millennium Development Goals (MDGs) of improving maternal and child health and combating priority infectious and non-communicable diseases;

• 2) Provide financial risk protection through expansion in the enrollment and benefit delivery of the National Health Insurance Program (NHIP); and

• 3) Improve access to quality health care which includes the upgrading of public hospital and health facilities, ensuring adequate health human resources and securing the availability of essential medicines.

NCD Control: Primary Care

• Non-communicable disease burden

• Hypertension control

• Diabetes control

• Asthma management

• Acute infections

Public Private Partnership • improve access to health facilities and services

• Infrastructure gap in the health system

• 5 hospital beds/10,000 pop.

• Long length of stay because of efficiency

• Lack of funds

• Brain drain

PPP▪ The project aims to raise health standards through the

upgrading and modernization of the facilities. The project components cover the following: • Construction of new healthcare building and facilities. • Hospital facilities involves the entire development and

identifying the services required, and overall delivery of services.

• Hospital Equipment, furniture & fixtures: Provision of medical equipment including hospital beds, etc.

• Total Computerization. Hospital Information system linked between medical and administrative as well as external stakeholders (Philippine Health Insurance Corporation (Philhealth), Department of Health (DOH), Department of Budget and Management (DBM), etc.).

• Training and Technology Transfer

www.doh.gov.ph

NKTI Hemodialysis Center

• Procured in 2003 under lease agreement for 5 years and was renewed again in 2009 • At present, there are 47 dialysis machines in operation at the new hemodialysis center

of NKTI • Status: Second contract is being implemented; third contract will be for bidding

www.doh.gov.ph

NKTI PET-CT and Cyclotron Project

• Include building construction in a 230 square meter vacant lot beside the Diagnostic Center of NKTI for housing of the Cyclotron for the production of fluorodeoxyglucose (FDG)

• Supply of equipment and related facilities in the operation of the Positron Emission Tomography (PET) and Computerized Tomography (CT);

www.doh.gov.ph

Modernization of Philippine Orthopedic Center

• PhP5.6 Billion £83.5Million • 700-bed capacity specialty hospital • Build-Operate Transfer Contract for 25 years. • Status: Ongoing procurement of Independent Consultant

www.doh.gov.ph

Modernization of Bicol Medical Center

• PhP855 Million (£12.7Million)– funded by the government through DOH • 800-bed capacity hospital • Design and Build Scheme – ongoing construction

www.doh.gov.ph

Modernization of Cagayan Valley Medical Center

• PhP305 Million (£4.55 Million) – funded by the government through DOH • 600-bed capacity hospital • Design and Build Scheme – ongoing construction

www.doh.gov.ph

Regional Cancer Centers

• PhP75 Million (£1.12 Million) – infrastructure funded by the government through DOH • Of the nine cancer centers, three (BGHMC, NKTI, RMC) has already its Oncology

Equipment provided by the Private Sector investor through sharing arrangement under Service Management Contract

• CVMC

• BGHMC

• ZCMC

• NMMC

• VSMMC

• WVMC

• BMC

• NKTI, RMC

• SPMC

Summary• Background information: Philippines

• Philippine Health System

• Government Procurement System

• Procurement of Medicines

• Health Financing

• Public Private Partnership

• Case discussion