Philippines Sentrong Sigla Movement

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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Lessons Learned • Credibility of certification depends on quality of assessment • Assessment should be accurate • Develop further skills of assessors

12. Lessons Learned • Minimal involvement of private sector reduced program impact • Enhance credibility of certification program if private sector is involved

13. 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