Annual Operational Plan 2012 Narrative

7/31/2019 Annual Operational Plan 2012 Narrative

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ANNUAL OPERATIONAL PLANPROVINCE OF CAVITE

(2012)

I. GENERAL DESCRIPTION:

A. BRIEF DEMOGRAPHIC PROFILE OF THE PROVINCE:

One of the fastest growing provinces in the country today, Cavite is a first class industrializing

province making up the CALABARZON area together with the provinces of Batangas, Laguna,

Quezon and Rizal. The province lies along the southeastern coast of Manila Bay and is bounded by

Metro Manila on the northeast, by the province of Laguna on the east and by the province ofBatangas on the south (Fig. 1.).Cavite has a total land area of more or less one thousand four

hundred twenty seven square kilometers (1,427.06) with a total population of three million fourhundred thirty two thousand nine hundred (3, 432,900); or a population density of two thousand

four hundred six persons per square kilometer (2,406 persons /km). Owing to a heavy influx of

inmigration of jobseekers from nearby provinces, the province has at present a high populationgrowth rate of around five and four hundred percent (5.4o%).

Health Resource Analysis

Fig. 1. Map of Cavite showing 7 political districts

Previously, the province is composed of only three (3) cities and twenty municipalities inthree (3) political districts but lately however, it has been divided into seven political districts and

one of its municipalities (Dasmarinas) has turned into a city; altering the provinces compositioninto nineteen (19) municipalities and four (4) cities (Table 1.). Of the four cities, one has been

classified as a first class city, two of them belong to the third class category while another one falls

on the fourth class category.


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On the part of the municipalities, four (4) are categorized as fifth class, (6) as fourth class

while the remaining nine belong to the second to first class categories. In addition to theaforementioned political districts, the province has also been subdivided into five (5) Inter Local

Health Zones (ILHZ) for health services delivery purposes. The subdivision for the Inter Local

Health Zones did not necessarily follow the pattern for that of the political districts but ratherconsidered or took into account the proximities of the member municipalities or cities to a higher

level health facility. This is the reason why the municipalities of Imus and Bacoor are members of

the Las Pinas ILHZ of the National Capital Region. (Table 2.). The City of Tagaytay has not joinedany Inter Local Health Zone (Fig. 2.).

Table 1. Political Districts of Cavite (as of 2009), N=7

Districts Municipalities / Cities

District 1 Municipalities of Kawit, Noveleta, Rosario and City of

Cavite

District 2 Municipality of Bacoor District 3 Municipality of Imus

District 4 City of Dasmarias

District 5 Municipalities of Carmona, GMA, Silang

District 6 Municipalities of Amadeo, Gen. Trias, Tanza and City

of Trece Martires

District 7 Municipalities of Alfonso, General Aguinaldo, Indang,

Magallanes, Maragondon, Mendez, Naic, Ternate andCity of Tagaytay

Table 2: Interlocal Health Zone, Distribution of Cities / Municipalities N=6

ILHZ Municipalities / Cities

AMIGA Amadeo, Mendez, Indang, Gen. Aguinaldo,

Alfonso

GenTaMar Gen. Trias, Tanza, Trece Martires City

MagNaMarTe Magallaes, Naic, Maragodon, Ternate

RosCaNovKa Rosario, Cavite City, Noveleta, Kawit

SiGmaCarDas Silang, Gen. Mariano Alvarez, Carmona

Dasmarias City

Las Pias ILHZ

Imus

Bacoor

Legend:

Cavitecity

Kawit

Noveleta

Rosario

Bacoor

Imus

TreceMartiresCity

Gen. TriasTanza

Tagaytay City

Silang

GMA

Carmona

Dasmarias

Ternate

Maragondon

Naic

Magallanes

Gen.Aguinaldo

Alfonso

Indang

Mendez

Amadeo

RosCaNovKa

GenTaMar

SiGmaCarDas

AMIGA

MagNaMarTe

The municipalities of Imus & Bacoorare included in the ILHZ of Las Pias

Tagaytay City is not included in anyILHZ

Fig. 2. Map showing the five Inter Local Health Zones (ILHZ) of Cavite.


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Health care services all over the province are jointly provided by the public and private health

facilities. As of 2010, Cavite has thirteen government owned hospitals of which one (1) is in aLevel IV category; another one is categorized as Level III; two as Level II; while all the remaining

nine (9) except for one specialized hospital (mental) are of the Level I category. On the other hand,

there are forty one (41) private hospitals operating in the province, of which two (2) are Level IV,seven (7) are Level III, twenty two (22) are Level II and ten (10) are Level I. To provide public

health services at the grass roots level, the province has likewise thirty five (35) Rural Health Units

and City Health Offices (RHUs and CHOs) as well as five hundred eighty nine (589) Barangay

Health Stations (BHSs). Although all thirteen (13) government owned hospitals are PhilHealthaccredited, only thirty five (35) of the forty one (41) private hospitals are accredited. In a likewise

manner, only fourteen (14) and nine (9) Rural Health Units out of 35 RHUs are accredited to

provide OPB and DOTS health services packages respectively. No RHU is accredited to provide

MCPs (Table 3.).

Health Facilities TotalNumber

No. and %

of

PhilHealthAccredited

LGU

Hospitals

No. and % of

PhilHealth

AccreditedPrivate

Hospitals

No. and % of

OPBAccredited

No. and %

of MCPAccredited

No. and % of

DOTSAccredited

Public hospitals 13

Private

Hospitals

41

Total 53 13

(100%)

35 (85.36%)

Rural HealthUnits (RHUs)

35 14 (40%) 0% 9(25.71%)

Barangay Health

Stations (BHS)

589 - - - -

Table 3. Status of Health Facilities, Province of Cavite, 2009

Manning the above mentioned Public Health facilities are a handful of public health

manpower struggling tirelessly to provide frontline health services within their respective localities

in the province. Although, some improvements have been gained for the past couple of years inincreasing the number of public health personnel in the Rural Health Units, almost all public health

services with regards to personnel key providers are outnumbered in terms of the ratio ofmanpower to the number of populations to be served as shown in Table 4. Moreover, the table onlyshows the average ratio for the whole province, so that in the more urbanized localities of the

province the ratios are in fact even lower; which admittedly affect efficiency and effectiveness in

providing public health services delivery in such localities.

Health Provider Number Ratio / 100,000

Population

Ideal Ratio / 100,000

Population

Doctors 45 1:64,744 1:20,000

Nurses 145 1:20,093 1:20,000

Midwives 334 1:8,723 1:5,000

Dentists 55 1:52,973 1:50,000MedicalTechnologists

32 1:82,923 1:20,000

Sanitary Inspectors 74 1:39,372 1:20,000

Nutrition Officer

(N.O.)

8 Only 9 N.O.* for 19

Municipalities and4 cities

1 N.O. per

municipality

Table 4: Profile of Public Health Care Providers, Province of Cavite (2011)


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B. THE GENERAL HEALTH SITUATION OF THE PROVINCE AT THE END OF 2010:

B.1. Assessment of the province based on the Province-wide Health System of the

LGU SCORECARD:

A comparative review of both of the 2009 and 2010 Province-wide LGU SCORECARDSUMMARY OF ACCOMPLISHMENT (Table 5 and Table 6 below) coupled with that of the

Vital Health Indices of Cavite for 2009 and 2010 suggests that the general health status of the

province has not improved much from that of 2009. Notably, the province has not performed quite

well in the areas of Service Delivery and Financing in 2010 compared to that of 2009. While onlyone (1) performance indicator under Service Delivery has shown a negative accomplishment in

2009, nine (9) indicators have in 2010. The same is true for indicators under Financing. Theprovinces performance with respect to these indicators has not changed; three (3) out of five (5)

indicators still have negative accomplishments.

LGU Scorecard

Priority Program

Thrusts(By Pillar)

No. of

Performance

Indicators

With Positive

Accomplishment

With Negative

Accomplishment

Service Delivery 17 8 9

Regulations 1 1 OFinancing 5 2 3

Governance 5 4 1

TOTAL 28 15 13

Table 5: LGU Scorecard Summary of Accomplishments Per Performance Indicator (2010)

LGU Scorecard

Priority Program

Thrusts(By Pillar)

No. of

Performance

Indicators

With Positive

Accomplishment

With Negative

Accomplishment

Service Delivery 16 15 1Regulations 2 2 0

Financing 5 2 3

Governance 5 5 0

TOTAL 28 24 4

Table 6: LGU Scorecard Summary of Accomplishment Per Performance Indicator (2009).

A more detailed study of the Province-wide LGU SCORECARD for 2010 will reveal that

although the Ave. PWHS for the prevalence and incidence rates of Leprosy and Rabies

respectively are far lower than the 2010 NOH targets, both has gone up slightly in 2010 whichmight require a little bit of attention. The same is also true for TB Cure Rate, as well as thepercentage of Fully Immunized Children and Contraceptive Prevalence Rate. All three have also

shown negative accomplishments.


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With respect to the capability improvement of the provinces health facilities; which in one

way or another is reflected on the average length of stay of patients in the hospitals; in the averageoccupancy rate, also in the average hospital gross deaths from maternal causes, including

BEMONC to population ratio and the percentage of Rural Health Units accredited by PhilHealth

for outpatient packages benefits (particularly OPB and MCP); the province has not fared anybetter. All the above indicators have likewise shown negative accomplishments.

Not to be over looked however, is the performance of the province in the area of Health

Financing. Note that the percentage of poor families enrolled in the NHIP has gone down fromforty two percent (42%) in 2009 to only 20.43% in 2010. Similarly, the percentages of Provincial

and Municipal Budgets allocated to health have decreased from twenty five percent (25%) and

eight percent (8%) respectively in 2009; to twenty two percent (22%) and six percent (6%) in

2010. Admittedly, more often than not, factors governing and or affecting the increase inpercentages of these indicators are beyond the control of the health program managers at the

provincial level who are tasked to pursue these thrusts. In one way or another, the negativeaccomplishments shown by these indicators might have indirectly affected the implementation of

the activities under Service Delivery; contributing somehow to a poorer performance during the

previous year. Consequently, the poorer performance of the province in implementing the activitiesunder Service Delivery might have led to the rising of the rates of the provinces Vital Health

Indices as seen in the accompanying table (Table 7). For instance, the rise in maternal deaths

(MMR) might be partly attributed to the inadequacy of BEMONC and CEMONC facilities

throughout the province aside from other contributing factors.

2009 2010Infant Mortality Rate (IMR) 5.33 6.65

Maternal Mortality Rate (MMR) 41.02 61.29

Crude Death Rate (CDR) 3.59 3.74

Crude Birth Rate (CBR) 21.75 20.16

Table 7: Vital Health Indices, Cavite Province, 2009-2010

Apart from the previously mentioned indicators however, most of the other remaining ones

under Service Delivery have shown satisfactory results including most of those under Regulation

and Governance. As can be noted from the scorecard, although the provinces TB Cure Rate

decreased by one percent from 75% to 74%; TB Case Detection Rate on the other hand hasincreased from 34.5% to 60.81%. The same could also be said for the indicators of programs in

malnutrition, breastfeeding, sanitation, facility based deliveries, and several others more. Theprovince has likewise managed to make some head ways in decreasing the average manpower to

population ratio among its Rural Health Units particularly for the Rural Health Physicians and

Midwives. It has also reduced further the ratio of BNB to barangays served from 1 is to 5.591 to 1

is to 3.30. Over all, despite having more indicators with negative results, the implementation of theAOP 2010 has managed to sustain the health developments gained by the province for the past

several years and maintained its general health status as that of the preceeding year ( 2009 ); as

evidenced by the Top Ten Leading Causes of Morbidity and Mortality. (Table 8,9 and Table 11).Note that the top ten leading causes of diseases and deaths for 2009 and 2010 do not differ much

form each other. In short and speaking generally, the causes of morbidity in both years were more

by infectious diseases while that of mortality were by degenerative and lifestyle diseases.


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Diseases Number Rate

1. Hypertension, HPN 124, 056 4,257.972. Acute Upper Respiratory Infection,

Unspecified

71,820 2,465.08

3. UTI, site not specified 10,982 376.94

4. Influenza, virus not specified 6,508 223.37

5. Non-infective gastroenteritis & colitis,

unspecified

6,480 222.41

6. Other specified respiratory disorders 5,580 191.52

7. Multiple open wounds, unspecified 5,473 187.85

8. Acute Nasopharyngitis 4,162 142.85

9. Bronchitis, not specified as acute or chronic 3,872 132.9

10. Disorder of the skin & subcutaneous tissue 3,618 124.18

Table 8: Leading Causes of Morbidity, 2010 Cavite Province, Rate per 100,000 pop.


1. Acute Upper Respiratory 18,664 723.89

2. Hypertension 10,293 399.22

3. Diarrhea 8,422 326.65

4. Influenza 5,363 208.00

5. Bronchitis 5,305 205.76

6. Pneumonias 5,107 198.107. Urinary Tract Infection 2,466 95.64

8. Wounds 1,815 70.39

9. Acute Tonsilo-pharyngitis 1,631 63.26

10. TB Respiratory 1,304 50.58

Table 9: Leading Causes of Morbidity All Ages: Cavite Province, 2009, Rate Per 100,000 Pop.


1. Pneumonia, unspecified 751 25.78

2. Acute Mycocardial Infection 746 25.6

3. Malignant neoplasm without specification 584 20.044. Hypertensive heart disease 515 17.68

5. Heart Disease, organic, unspecified 455 15.62

6. Cardiovascular disease, unspecified 407 13.97

7. Acute Renal Failure 371 12.73

8. Respiratory Tuberculosis 330 11.33

9. Unspecified Diabetes Mellitus 329 11.29

10. Atherosclerotic heath disease 283 9.71

Table 10: Leading Causes of Mortality, 2010, Cavite Province, Rater per 100,000 pop.


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1. Cancer 819 31.77

2. Pneumonia 743 28.82

3. Heart Disease 717 27.814. Acute Myocardial Infraction 633 24.55

5. Hypertensive Vascular Disease 592 22.96

6. Diabetes Mellitus 388 15.05

7. Renal Failure 352 13.65

8. Tuberculosis 326 12.64

9. Degenerative Diseases 291 11.29

10. Cerebrovascular Accident 276 11.00

Table 11: Leading Causes of Mortality, 2009, Cavite Province, Rate per 100,000 pop.

II. THE LOCAL HEALTH PRIORITIES FOR 2012:

In setting up the local health priorities for 2012, the Province-wide Investment Plan for Health(PIPH) was again reviewed and re-assessed together with that of the Annual Operational Plan for

2011 (AOP 2011). The results from the analytical review and re-assessment of the two documents

including those from the evaluation of the LGU SCORECARD for 2010 have served as the bases aswell as the guidelines in re-adjusting the planned local health priorities for 2012 as contained in the

PIPH in order for them to be more responsive to the provinces current general health situation. Care

have been also taken to ensure that these priorities are linked with the major thrusts of the NationalGovernment and the CHD in support of attaining the National Objectives for Health, the MDGs and

the goals and objectives of Universal Health Care (UHC).

Emerging health problems and lifestyle related diseases were likewise identified by going overthe Internal and External benchmarks of the LGU SCORECARD; while programs and activities

from the AOP 2011 which the province has not been able to implement were also considered and

included for implementation in 2012.

Emerging from all the preceeding considerations are the general key areas from which the

provinces local health priorities were strategically focused; in consonance with the six (6) strategicinstruments of Universal Health Care. In summary therefore, the local health priorities of the

province are broadly outlined as follows:

1. Health Financing:a. Expansion of NHIP Enrollment:

To improve financial risk protection of its poor and most deserving constituents,

the Provincial Government has allotted Php 11,225,000.00 for enrolling the poor andindigents in the NHIP of the National Government. In addition to this, MLGUs and

other partner agencies are also very supportive of the PhilHealth Sabado Program.

b. There is also a need to intensify advocacy to increase the accreditation of health

facilities in the province for TB and PTB especially MCP packages to address the

increasing demand for these services as a result of increasing enrollment.

c. MLGUs has adopted the National Household Targeting System (NHTS) in enrollingindigents despite some issues and concerns in the manner / system of listing

indigents.


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2. Service Delivery:a. Improvement in the delivery of quality health services through:

a.1. Health Facilities Enhancement:

establishment of BEMONC and CEMONC facilities

upgrading / renovation of existing health facilities.

provision of equipments.

establishment of new health facilities.

Training of BEMONC teams in the following five (5) priority areas:

(Dasmarias, Indang, Amadeo, Gen. Trias and Tanza.)

Establishment of functional Womens Health Teams (WHT) deliverynetwork once a referral system is formulated.

b. Attainment of MDGs:b.1. Increased rates in:

TB CDR TB CR

b.2. Decreased Rates in:

Maternal death thru increased facility based deliveries

IMR

CDR

b.3. Increased rates in

FIC

CPR Skilled Birth Attendants

c. Emerging Health Problem:

Dengue Prevention and Control Program

HIV-STI

d. Lifestyle Related Health Problems:

Diabetis

Cancer

Smoking

e. Public-Private Partnership Enhancement:

e.1. Strengthening partnership with PRISM for technical assistance in

developing Family Planning (FP) and Maternal and Child Health (MCH)

PROGRAMS:

CSR Plan

CBMIS

Referral System Enhancement of FH Programs in Workplaces

Inclusion of Private Health Facilities in Service Delivery Network.

Reporting of Accomplishments (CPR,SBA,FBD)

f. Implementation of unimplemented AOP 2011 planned programs and activities.


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3. Policy, Standards and Regulation:

a. Formulate and adopt policies to ensure health services accessibility to all,

particularly the poor and the indigents; and the attainment of MDGs.b. Conduct advocacy for Facility Based Deliveries (FBD) and Newborn Screening.

c. Ensure availability of low cost essential drugs and medicines through BNBs.

d. Public Private Partnerships in TB-DOTS program, Voluntary Blood Donationprogram

e. Intensify the enforcement / implementation of Environmental Sanitation Rules and

Regulations.

4. Governance for Health:

a. Improve efficiency in the provision of health services by increasing bed occupancy

rate; decreasing the average length of patients stay in hospital facilities.

b. Promote transparency in all health related transactions.

5. Human Resources for Health:

a. Provision of additional manpower as per the Rationalization Plan of the province

(RAT PLAN).

b. Provision of Magnacarta Benefits to all health workers.

6. Health Information:

a. Implementation of e-FHIS, PIDSR, SPEED, in health emergencies.

b. Provide IT equipments to HF (HOMIS for Hospitals).

c. Provide adequate funds for IT services.

III. THE MAJOR THRUSTS OF THE AOP 2012:

The less than satisfactory performance of the province in several health program indicators as

portrayed by the External Benchmarks in the 2010 LGU SCORECARD has exerted muchinfluence in the formulation of the AOP 2012 strategic thrusts. As can be noted from the

Scorecard, the province has still a low percentage in the number of poor families enrolled in NHIP.

In the prevention and control of communicable diseases, there is still much room forimprovement as evidenced by the top ten leading causes of mortality where respiratory

tuberculosis still ranks number eight. Similarly, TB Case Detection and TB Cure rates are still way

below the 2010 NOH targets. It could likewise be noted from the Vital Health Indices of theprovince that both the IMR and the MMR have gone up considerably for the past two years

compared with those of 2007; while the average bed occupancy rate of its lower level hospitals

remain quite below the average 2010 NOH target.

The poor showing of these indicators evidently requires more committed attention in the areas

of health facilities improvement, health care financing and in the efficiency, effectivity and

responsiveness of health services delivery.

In an effort therefore to further improve the performance of the province in the above

mentioned areas of concerns while sustaining the health reforms and improvements it has gainedso far; as well as in keeping attuned to the goals and objectives of Universal Health Care; the AOP

2012 has focused its implementation agenda in pursuing the following general strategic thrusts:


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1. Financial Protection Through Expansion in NHIP Enrollment and Benefit Delivery:

Increase the percentage in the number of poor families enrolled in NHIPthrough advocacy and coordination with partner agencies and organizations

including informal sectors. Adoption of NHTS in identifying indigent families

Increase the number of Philhealth accredited facilities for TB-DOTS, MCP and

OPB healthcare packages.

Increase LGU investments for health to at least 15%.

Source out endowment funds for indigent patients.

Establishment of Local Health Accounts using 2011 data.

2. Improved Access to Quality Hospitals and Other Health Care Facilities:

Rationalization of Local Health Facilities to include establishment of BEMONC

facilities in some satellite hospitals, rural health units, lying-ins and barangayhealth stations.

Upgrade a municipal hospital and six (6) satellite hospitals

Construction of new additional twenty five (25) bed and fifty (50) bed capacityhospitals.

Strengthen public-private partnerships for the formulation or establishment of

financial mechanisms to support health facility enhancement programs andprojects.

Improvement of government owned health facilities through income retention.

Enforcement of National Health Legislations and other health related Policiesand Standards.

Ensuring the availability and access to low-cost quality essential drugs andmedicines and other health commodities particularly to the poor and the

indigents who needs them the most.

Strengthening the Local Health System development and improve referral

network system to address fragmentation of health services within a particular

inter-local health zone.

trengthening Local Human Resource Management System to improve the

frontline health manpower to population served ratio in all public health

facilities of the province.

Institutionalization of monitoring and evaluation of health reforms to trackdown and evaluate implementation of health programs, projects and activities

and indentify and address issues and concerns affecting each program or

activity.

Strengthening Health Information System and data gathering.

3. Attainment of Health Related MDGs:

Sustaining the efforts on establishing disease free zones such as malaria, rabies

and leprosy.

Intensifying efforts on prevention and control of both communicable and non-

communicable diseases including emerging and re emerging health problems to

reduce morbidity and mortality and the prevalence of emerging diseases such asHIV/AIDS.

Improvement of Reproductive Health Outcomes to reduce maternal and child

mortality.

Intensifying Healthy Lifestyle and Management of Health Risks to reduce theprevalence of lifestyle related diseases including degenerative diseases.

Intensifying enforcement of Environmental Sanitation rules, regulations,

standards and policies.

Strengthening Disease Surveillance and Epidemic Management System.

Strengthening Disaster Preparedness and Response System.


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IV. PERFORMANCE INDICATORS FOR THE AOP 2012:

The performance of the province in the implementation of the AOP 2012 shall be gauged

in general by monitoring the progress made upon the institution of its programmed measures

and interventions based on the following indicators:

A. Public Health Service Delivery:

a.1. Increased percentage in the number of poor and indigent families

enrolled in NHIP.a.2. Improvement on the provinces vital health indices such as decreased

IMR, MMR, CDR and CBR.

a.3. Decreased incidence rates of communicable and non-communicable

diseases.a.4. Decreased prevalence of lifestyle related and degenerative diseases

including emerging health problems (HIV/ AIDS).

a.5. Increased percentage of Fully Immunized Children includingnewborns initiated to breastfeeding.

a.6. Reduced prevalence of malnutrition and common childrens illnesses

among under five children.a.7. Increased or sustained percentage in the number of households with

access to safe drinking water and basic sanitation facilities.

a.8. Improved availability and accessibility of low-cost essential drugs,

medicines and other health commodities to the poor and the indigents.a.9. Improved health information system and referral network.

a.10. Increased percentage of Local Health Budgets allocated to Health.

a.11. Strengthened disease surveillance and epidemic management system.

B. Hospital Services

b.1. Improved quality of service resulting to a decreased average length of

patients stay in hospital facilities.

b.2. Increased Bed Occupancy Rates of Lower Level Hospital facilities inthe province.

b.3. Upgraded and expanded hospital capacities and capabilities to be

responsive to traumatic injuries and other health emergencies.

b.4. Strengthened hospital facilities and manpower in disasterpreparedness and response system.

V. AOP 2012 Matrix of Activities

VI. Supplemental Plans:

a. Annual Training Plan

b. Project Procurement Plan

c. Financial Plan

VII. Appendices:

a. LGU SCORECARD (2010).

Annual Operational Plan 2012 Narrative

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