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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