Philippines Sentrong Sigla Movement Improving the Quality of Health Services in a Decentralized Health System: Lessons Learned from a National Certification Program Philippines Sentrong Sigla Movement

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

Lessons Learned 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