1 Name of forum Presentor/date/month/year Republic of the Philippines NATIONAL STATISTICAL COORDINATION BOARD Administrative Data Key to Health Policies

1 Name of forumPresentor/date/month/year

Republic of the PhilippinesNATIONAL STATISTICAL COORDINATION BOARD

Administrative Data Key to Health Policies and Programs: Philippine

Experience1

by

Estrella V. Domingo2

Inter-Secretariat Working Group-Health Statistics Meeting

International Association for Official Statistics Conference

14-17 October 2008, Shanghai, China

1 Paper presented at the 2008 IAOS Meeting, Shanghai, 17

October 2008 China on the ISWG-HS Session

2 Assistant Secretary General of the National Statistical

Coordination Board (NSCB) of the Philippines



Administrative Data Key to Health Policies and Programs: Philippine Experience1

Outline of Presentation

I. INTRODUCTIONII. ADMINISTRATIVE DATA SOURCESIII. USES OF ADMINISTRATIVE DATAIV. COORDINATIVE MECHANISMSV. PROBLEMS AND ISSUESVI. RECOMMENDATIONS, FUTURE

DIRECTIONS (ACTION PLAN)

Inter-Secretariat Working Group-Health Statistics MeetingInternational Association for Official Statistics ConferenceEstrella V. Domingo/ 14-17 October 2008, Shanghai, China




I. INTRODUCTION

The Philippines adheres to the principle of protecting and promoting the right to health of the people and at the same time instilling health consciousness among them (guaranteed by the 1987 Constitution, Article II, Section 15).

Health care system in the Philippines is generally extensive although access to health services, especially by the poor is still hampered by high cost and physical and socio-cultural barriers (National Objectives for Health, 2005-2010) .





I. INTRODUCTION

In the latest Philippine National Health Accounts (PNHA), the share of private out-of-pocket expenditure on health increased farther, to 12.9 percent, from 11.9 percent.

Thus, reforms in the country’s health system continues. In 1999, the Department of Health (DOH) launched the Health Sector Reform Agenda (HSRA) as a major policy framework and strategy to improve the way health care is delivered, regulated and financed (NOH, 2005-2010).





I. INTRODUCTION Health plans, policies and programs

require timely, relevant, reliable and specific data as critical inputs to address present health concerns and ultimately to achieve better health for the country.

Based on the latest assessment of the Philippine health information systems conducted under the Health Metrics Network (HMN) Project, data for planning and priority setting are more general and, thus, the available data are considered to be adequate.

However, for health policy making and intervention programs, where more specific data are needed, health data are rated as inadequate.Inter-Secretariat Working Group-Health Statistics

MeetingInternational Association for Official Statistics ConferenceEstrella V. Domingo/ 14-17 October 2008, Shanghai, China




I. INTRODUCTION Specifically, one of the problems cited

is data from administrative records, are underutilized because of quality problems. While excessive data are being collected administratively by the DOH and other concerned government agencies, these are found to be erratic, lack the needed details or are incomplete, fragmented and irregular and lack the required statistical standards.

This paper is intended to highlight the role of administrative data based on Philippine experience, identify problems and recommend solutions towards improving and maximizing its use for planning, policy and program intervensions.





II. ADMINISTRATIVE DATA SOURCES


The Philippines obtains its health data from two major sources: surveys and censuses and from administrative records of health and health related agencies.A. Surveys and Censuses

Health Surveys and Census are limited to the following:

The National Demographic and Health Survey (NDHS) is undertaken by the National Statistics Office (NSO) once every 5 years to provide national and regional estimates of levels and trends of fertility as well as examines the differentials and determinants of fertility. It also yields information on family planning, childhood and adult mortality, maternal and child health, and knowledge and attitudes related to HIV/AIDS and other sexually transmitted infections. The National Health Survey of DOH was incorporated in the NDHS starting 1993.






A. Surveys and Censuses

The annual Maternal and Child Health Survey (MCHS) also conducted by the NSO generates information on the coverage and effectiveness of the maternal and child health programs of the DOH at the regional level.

The Family Planning Survey (FPS), undertaken by the NSO also once every 5 years covers data on prenatal and postpartum care, protection at birth against neo-natal tetanus, breastfeeding and immunization.

The Census of Population and Housing (CPH), carried out once every 10 years by the NSO, collects data on population count and housing characteristics. It generates indictors on life expectancy at birth, child and adult mortality.






B. Administrative – Base Data

In addition to the surveys and censuses, the DOH and other government agencies separately collect and maintain data that can be used for monitoring and assessing the health status of the Philippines. The administrative data serves as supplementary data to augment the extensive data required for planning, policy formulation and program interventions on health. With the large contribution of the private sector, monitoring and evaluation of their services are best obtained through administrative data. The following are some agencies and bureaus involved in collecting administrative health information:







1. Department of Health (DOH) continues to provide / generate the bulk of data for the health sector which are obtained mostly from administrative reports regularly furnished by public hospitals, rural health units (RHUs) and other local government health units.







1. DOH National Epidemiology Center comes up with an annual report, Philippine Health Statistics (PHS) which contains a summary of statistical data on births, deaths and notifiable diseases registered and reported through the Notifiable Diseases Registry of the Field Health Service Information System (FSHIS) submitted by the RHUs and barangay health services (BHSs). Diseases, injuries and health conditions are coded using the International Classification of Diseases version 10. The different data systems being generated by different offices in DOH can be classified into 4 categories: health service delivery system; health regulation systems; health governance systems; and other systems.







1-a. Health service delivery system

• A major source of data for the DOH is the FSHIS. It provides information on the different public health programs such as: maternal and child health; nutrition; family planning; Expanded Program on Immunization; Mental health; Communicable Disease Prevention and Control (TB, Malaria, Schistosomiasis, Lepsory); Environmental Health; Vital Statistics (natality, mortality, population); and notifiable disease reporting system. Data comes from local field health personnel through the regional and provincial health offices and consolidated at the central office. These are presented by province, city and region in the Annual FSHIS Report.








• The Health Management Information System (HMIS) is made up of several subsystems, two of which are the Hospital Management Information System (HOMIS) and the Rural Health Unit Information System (RHUMIS). The HOMIS generates information on hospitals to support the delivery of hospital services and the management of the hospital while the RHUMIS is designed for the rural health units to efficiently and effectively monitor patient cases.

• The surveillance systems include 2 major disease surveillance systems which provide data on notifiable diseases: the Weekly Notifiable Disease Reporting System (WNDRS) and the National Epidemic Sentinel Surveillance System (NESS).








• Registries (HIV and AIDS, Diabetics, Injuries, Cancer, Persons with Disabilities (PWD), Tuberculosis (TB), Renal Diseases) which are maintained by various professional societies and non-government organizations.






1-b. Health Regulation System

• Health Product Regulation and Health Establishment Regulation

• Health Facilities and Services Regulation

• Health Devices Regulation

1-c. Health Governance System

Under this group are information systems focused on collecting data on plans and programs of the different DOH units, registrations, licensing and accreditation of health facilities, training conducted, etc.







2. Philippine Health Insurance Corporation (PhilHealth)

Philhealth as part of its mandate provides and maintains database systems on health insurance and financing and accreditations of health providers and health facilities.







3. National Statistics Office (NSO)

The NSO as mandated by the Civil Registry Law generates vital health statistics such as marriages, births, deaths, infant deaths, fatal deaths, maternal deaths, and mortality by leading causes. These data are recorded on birth, marriage and death registration forms.




III. USES OF ADMINISTRATIVE DATA


Administrative data, which provide more specific information, are preferred for health policy formulation and intervention programs. This is true in the case of the Philippines which compels/requires the DOH and other health related agencies to gather administrative data to address current health problems at all levels of governance. Two of the most important administrative data are described in detail in this report.





A. Field Health Service Information System (FHSIS)

The FHSIS to date, developed by the DOH, is the only information system that is in place down to the barangay level. Although still limited in coverage to existing government facilities present in the communities, e.g. barangay health centers, rural health units, municipal, city or provincial hospitals, the FHSIS remains viable because of the dedication of the field health personnel who recognizes the importance of information for an effective health service delivery.






A. Field Health Service Information System (FHSIS)

For the DOH, the FHSIS serves as a major source of data for all its different public health programs to monitor activities in each of these programs on a routine basis (weekly, monthly, quarterly, or annually).

The most common uses of FHSIS, particularly for the municipal and provincial planning offices are:

1. Planning and prioritization of activities

2. Reporting and bases for accomplishments; and

3. Resource allocation and budget estimation






B. Civil Registration system (CRS)

The CRS being implemented at the local level by municipal local registrars/local government units and pursuant to the Civil Registration Law record reported births, marriages and deaths occurring in the municipality with information on the place of origin of the patients. The assessments rated this as adequate.






B. Civil Registration system (CRS)

The major applications of civil registration data are for:

1. Planning and Prioritization;

2. Resource allocation and budget formulation;

3. Profiling of the province

4. Monitoring birth, growth and death growth rate; and

5. Population projections






Many government and non-government agencies are involved in collecting and generating health statistics. Different frameworks are available and used as basis for identifying indicators/statistics for monitoring and evaluating the progress and effectivity of the country’s health plans, policies and programs. These indicators are also used as frameworks for statistical coordination.

These frameworks include the Millennium Development Goals (MDGs), Philippine Statistical Development Program (PSDP), PNHA, Medium Term Philippine Development Plan (MTPDP), and National Objectives for Health (NOH).

IV. COORDINATIVE MECHANISMS





The NSCB as the highest policy making and coordinating body on statistical matters has put in place coordinating mechanisms to ensure generation of quality statistics for planning and policy making. These mechanisms inlcude:

System of Designated Statistics (SDS)

The SDS, is a mechanism for the identification and generation of crucial statistics for administrators, planners policy makers and decision makers in the government and private sectors. It is also an important tool to address data gaps, duplication, delayed release and inaccessibility of important data sets.






The NSCB as the highest policy making and coordinating body on statistical matters…

System of Designated Statistics (SDS)

Designation includes assigning the implementing agency, frequency of data collection, geographic disaggregation and schedule of data dissemination.






The NSCB as the highest policy making and coordinating boy on statistical matters…

Inter-Agency Committees (IACs) / Working Groups are created to (1) assess and evaluate the quality, usefulness and timeliness of sectoral data and determine areas of duplication, discrepancies and gaps; (2) review concepts, techniques and methodologies used in the collection, processing and reporting of data; and (3) recommend an efficient and workable scheme for the allocation of agency responsibilities in the production of statistics.







Inter-Agency Committees (IACs) / Working Groups….

The IAC on Health Statistics takes statistical issues on health statistics such as duplications, prioritization, standardization of concepts and methods, ensuring quality of statistics, etc. Resolutions of issues/concerns are recommended by the IAC on Health Statistics for approval of the NSCB Board. The IAC includes members from various agencies concerned with health statistics. It is chaired by the undersecretary of the DOH.







Philippine Statistical Development Program (PSDP)

The PSDP serves as the blueprint of the integrated vision and priority programs and projects to be undertaken in the PSS for the medium term in order to meet current and emerging needs of the national and local planners, policy makers and data producers. The formulation of the sectoral development programs is spearheaded by the NSCB through the various inter-agency committees, task forces and working groups composed of the key players and stakeholder in the different sectors of the PSS. Indicative budget requirements for the programs and activities are also included.







Philippine Statistical Development Program (PSDP)

The PSDP chapter on Health is guided by the development priorities for health as identified in the statistical framework for health and nutrition in the PSDP. The six components are: health status, health resources, health services, nutritional status. Nutritional resources and nutrition services.






The recent HMN assessment of data sources revealed/reported that administrative data, although available, were generally considered inadequate.

Specific problems:

Difficulties in submitting completed forms

Lack of awareness and appreciation on the importance of the data

High degree of inaccuracies in data collected

Not all items in the form are filled out or completed

Lack of software for processing data

Lack of training for health workers collecting data

V. PROBLEMS AND ISSUES ON THE USE OF ADMINISTRATIVE DATA





The results of the assessment using the HMN framework brings to fore the status of health information in the Philippines. The following recommendations are focused on improvements of the administrative data which provides the bulk of data needed for health policy formulation and program interventions.

1. Develop a comprehensive and coordinated health data framework.

2. Strengthen coordination; and the Philippine Health Information Network.

VI. RECOMMENDATIONS





The results of the assessment using the HMN framework brings to fore the status of health information in the Philippines….

3. Widen appreciation and utilization of health statistics, specifically the FHSIS in health program management.

Capacitate health care facilities, health workers and local officials on health information.

VI. RECOMMENDATIONS






Invest in health statistics and information

Substantial/Adequate resources are needed from the DOH and LGUs to improve data collection, develop information systems, information infrastructure such as IT equipment, internet connection, etc. and equip/develop human resources with the needed statistical and IT skills.

VI. RECOMMENDATIONS






Revisit and re-engineer the FHSIS and other legacy systems

With the current developments in public health and local governance, the FHSIS has to be overhauled and updated to enhance its utilization and address quality problems such as timeliness and reliability. The FHSIS can be improved with the use of the IT and stronger collaboration between the DOH, local government units and statistical agencies.

VI. RECOMMENDATIONS



Maraming Salamat po!

URL: http://www.nscb.gov.ph e-mail: [email protected]@nscb.gov.ph

Documents

1 Name of forum Presentor/date/month/year Republic of the Philippines NATIONAL STATISTICAL COORDINATION BOARD Administrative Data Key to Health Policies