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John Q. Wong, MD, MSc Justine Joyce Alim, Jose Lorenzo Angeles, Pia Cerise Creencia,

An Assessment of Health Reform Status in Leyte, Southern Leyte, Oriental Mindoro, and Occidental Mindoro Using the Indicators from the LGU Scorecard: A Cross-Sectional Study. John Q. Wong, MD, MSc Justine Joyce Alim, Jose Lorenzo Angeles, Pia Cerise Creencia,

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John Q. Wong, MD, MSc Justine Joyce Alim, Jose Lorenzo Angeles, Pia Cerise Creencia,

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  1. An Assessment of Health Reform Statusin Leyte, Southern Leyte, Oriental Mindoro, and Occidental Mindoro Using the Indicators from the LGU Scorecard: A Cross-Sectional Study John Q. Wong, MD, MSc Justine Joyce Alim, Jose Lorenzo Angeles, Pia Cerise Creencia, Arnel Christian Dy, Raymond Joseph Escalona Health Sciences Program 10th DOH National Health Research for Action Forum 26 June 2009 Heritage Hotel

  2. Introduction.

  3. Background Information FOURmula One (F1) Program (2006) Targets: • Financing • Service Delivery • Governance • Regulation *based on Roberts’ five health system control knobs Outputs: Access Efficiency Quality Outcomes: Financial Equity Health Status Customer Satisfaction

  4. Background Information Tie-up with the DOH’s Monitoring and Evaluation for Equity and Effectiveness (ME3) Project • Develop a baseline analysis of health reform efforts in the different levels of the local health system: • Provincial • Municipal Level Propose an improved, more efficient, and less costly means of obtaining and processing health data

  5. Significance of the Study One of the issues in the Philippine health system is providing a clear representation of health status in various areas with the quality of available secondary data…

  6. Government Mayor Governor Department of Health Outside institutions Grants providers Pharmaceuticals The Filipino People the health of the family Stakeholders

  7. Objectives • To determine and compare health reform status of selected F1 and non-F1 provinces • To determine the costs of an online data collection system and compare it with the currently-implemented methodology

  8. Methodology.

  9. Study Design • Variables used are specified in the LGU Scorecard variables list • Secondary data collection from: • PHO • PHIC provincial offices • Provincial and district hospitals • MLGUs • RHUs

  10. Study Design • Error minimized through: • Decomposition of indicators • Verification of definitions during • Data collection • Post-data collection • Checking if other forms have the same data • Verification of data from local sources • Phone calls • Email

  11. Study Design Descriptive Statistics • Performed on 2007 data • Measure of central tendency: median (w/ range) Analytical Statistics • Bivariate Analysis: Moses Test for Extreme Reactions • Regression: Multiple Regression Cost Comparison Analysis • Comparison of costs

  12. Study Population IV-B MIMAROPA Region VIII F1 Pretest Non-F1

  13. 28 LGU Scorecard Indicators

  14. 28 LGU Scorecard Indicators

  15. 28 LGU Scorecard Indicators

  16. Descriptive Statistics • descriptive statistics per indicator in all four provinces • based on 2007 health data • includes mean, median, range, % incomplete • basis for the trimming down of indicators and municipalities for analysis

  17. Descriptive Statistics Ranking • used for determining levels of performance within a criterion and for comparison of multiple criteria with varied units • 1 – highest rank • Higher quotient value would have a higher rank except for • #8:Percentage of Protein Energy Malnutrition among 0-5 years old based on weight for age anthropometric measurement • #13:Average length of stay in hospitals in days • #14:Average occupancy rate for 1st to 3rd level public and private hospitals • #15:Average hospital gross death rate from maternal causes • #23:Percentage of Maintenance and Other Operating Expenses (MOOE) to total health budget

  18. Vertical Analyses • Data segregated into provinces. • Maintained municipalities were ranked based on their quotient values for each indicator. • Rank exactly at the middle of the range of all the indicator ranks attained by each municipality = median rank • Median ranks of municipalities were again ranked (overall rank) and organized into quintiles.

  19. Vertical Analysis: Comparison of Municipalities’ Overall Performances

  20. Horizontal Analyses • Data segregated into provinces. • Indicator performance based on quintile values • ranked • grouped into quintiles • Indicators are classified under health reform pillars • Pillar Score = average of indicator rankings • Ranking of pillar performance

  21. Horizontal Analysis: Comparison of Performances in Each Municipality and Province

  22. Bivariate Analysis & MR • Moses Test for Extreme Reactions • non-parametric (convenience sampling) • determined which indicators had significant effects on health outcomes (F1 vs. non-F1) • Multiple Regression • measured the magnitude of the effects of the significant variables from bivariate analysis

  23. Head-to-head comparison of two cost categories Workshop cost Data Collection Cost Cost Comparison Analysis

  24. There was a constant display of: Professional and Appropriate conduct Proper etiquette in dealing with persons of higher authority and public office workers Ethical Considerations

  25. Results.

  26. Descriptive Analyses • Descriptive Statistics • Vertical Analysis • Horizontal Analysis Purpose To analyze the data set as a whole in regards to the mean, median, and range of values, as well as the skewness, kurtosis, and percentage of missing valuesfor each indicator

  27. 1. Descriptive Analysis • Based on the quotients from the raw data • the minimum and maximum • mean, median, and mode • standard deviation, skewness, and kurtosis • Provided a count of the entries that were problematic • Total completeness of data: 95.34% 5 Variables were dropped, <20%

  28. 2. Vertical Analysis Purpose To compare the performances of the province’s municipalitiesfor each LGU indicator (representative of health projects and programs) To show the overallbest and worst performing municipalities for each province

  29. F1Vertical Analysis Results Oriental Mindoro Southern Leyte

  30. Non-F1Vertical Analysis Results Occidental Mindoro Leyte

  31. 3. Horizontal Analysis Purpose To compare health reform programs within a municipality To show the overall performance of the health programs with in the province To show the overall F1 pillar performance within the province

  32. F1Horizontal Analysis Results Oriental Mindoro Southern Leyte

  33. Non-F1Horizontal Analysis Results Occidental Mindoro Leyte

  34. Statistical Analyses • Bivariate Hypothesis Testing Moses TestMonte Carlo Simulation • Multiple Level Regression Modeling

  35. 1. Bivariate Hypothesis Testing Purpose To determine whether F1 and non-F1 municipalities differ from each in terms of the 25 variables • Moses Test for Extreme Reactions • Non parametric • Non random sampling

  36. Bivariate Hypothesis Testing Preparation • All variables taken from 2007 data • Missing replaced with mean Results: 14 Significant Variables

  37. Significant Variables from Bivariate Analysis

  38. Bivariate Hypothesis Testing

  39. 2. Enter Multiple Regression Modeling Preparations • Non-random sampling controlled • province population and the municipality populations • ratio of muni popln to prov popln • After Pearson’s correlations: all were maintained

  40. 2. Enter Multiple Regression Modeling Interpretation • Higher rank in LGU Scorecard significantly associated with • F1 status • Presence of a PHIC-accredited RHU • These two factors account for 34% of an LGU’s performance in the scorecard

  41. Cost Comparison Analysis

  42. Discussion.

  43. LGUs as patients Dysfunctional health system as the disease Scorecard as a screening or diagnostic test Health reforms as treatment Analogy

  44. Indicators measure health and health-related events (signs and symptoms) Indicators are diagnostic tests Indicators lead to Diagnosis and treatment Indicators in LGU Scorecard

  45. Disease Diagnostic test Diagnosis and treatment -Wilson JMG and Jungner G, Principles and Practice of Screening for Disease. WHO, Geneva: 1968. Wilson and Jungner’sCriteria for Disease Screening

  46. The condition sought should be an important health problem Broken health system as a disease There should be a recognizable latent or early symptomatic stage Not applicable since disease is already present Disease

  47. Disease • The natural history of the condition, including development from latent to declared disease, should be adequately understood • Indicators measure intermediate health outputs that lead to the F1 health outcomes • However, many unknowns in process of health reform

  48. There should be a suitable test or examination Performance of LGU Scorecard needs to be tested by time The test should be acceptable to the population Routine data Diagnostic Test

  49. There should be an accepted treatment for patients with recognized disease Interventions (reforms) have been defined and are available Diagnosis & Treatment

  50. Diagnosis & Treatment • Facilities for diagnosis and treatment should be available • Need to build local capacity to • Utilize the LGU scorecard • Innovate and implement reforms

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