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Philippines

Health Systems 20/20, in cooperation with USAID/Philippines, conducted a pilot demonstration of citizen participation in health governance from June 2009 to August 2010.

The goal of the pilot project was to demonstrate increase in the utilization of MCH services through improvements in health governance at the facility level. In three sites in Mindanao, Health Systems 20/20 supported the establishment of facility-based governance committees that focus on improving quality of health services: Quality Assurance Partnership Committees (QAPCs).

The QAPC is a governance mechanism that brings together local leaders and government officials, health service providers, civil society, and community representatives to address issues related to access, availability, and quality of maternal and child health related services in local facilities. The committees can give civil society a voice in health service delivery and quality and at the same time, can increase the accountability of local officials and providers to their communities for services delivered.

The QAPC was envisioned to provide oversight and problem solving actions to improve maternal and child health services in the three pilot facilities. Through a grant from Health Systems 20/20, the Gerry Roxas Foundation (GRF), a local NGO, facilitated the introduction, organization, and functioning of QAPCs in the three demonstration sites, with enthusiastic support from elected officials, health facility managers, and local officials. The three sites were:. the Rural Health Unit in the municipality of Lopez Jaena, the City Health Office in Oroquieta City, and the Provincial Hospital in Compostela Valley.

From an end-of-project assessment field visit conducted in July 2010, the following findings emerged:

• Anecdotal evidence suggested that community participation via the QAPCs contributed to client-focused and responsive MCH service delivery, expanded outreach from the facility to MCH service users, and increased MCH service utilization. The QAPCs strengthened the linkage between facilities and service users by sensitizing communities regarding MCH issues, and mobilizing community members to utilize available services.
• The major governance outcome at the facility level was increased responsiveness to community needs and preferences. A related secondary outcome was some increase in accountability to clients. Beyond governance at the facility level, the QAPC experience demonstrated the importance of decentralized local government to the effective functioning and sustainability of a co-governance innovation that brings together citizens and public-sector health providers.
• The integration of the QAPC pilot with the Philippines Department of Health’s existing quality assurance program, the Service Delivery Excellence in Health (SDexH) initiative, was critical to the success of the demonstration project. SDexH provides an accepted framework that connects quality clinical standards and accreditation to a definition of quality that incorporates client perceptions and community input.
• The potential for institutionalization of the QAPCs was enhanced by the ownership of the concept by local government officials. In all three cases, local chief executives issued Executive Orders giving official recognition to the QAPCs, and were strongly supportive of the committees.

Two of the three QAPCs received a commitment from local governments to provide ongoing financial support to cover expenses for community members to participate in the committees. In the Compostela Valley Provincial Hospital, the director included the QAPC as an activity the Wellness Center, which assures the committee ongoing support and a venue. The demonstration project team drafted a QAPC process guide for use by other local governments in the Philippines that are interested in replicating the committees for health facilities in their jurisdictions.

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Photo Credit: Derick Brinkerhoff