1-1 Background of the Project In the Philippines, the number of sickbeds and doctors were insufficient for a certain number of population as well as the medical facilities and medical equipment of the national and public hospitals. The Benguet General Hospital, which plays the core role in the referral system in the province of Benguet, could not fully meet the medical demand, and the inadequate capacity of the hospital hindered the provision of medical treatment. Furthermore, a system for residents to receive basic medical treatment at local hospitals and rural health units in mountainous area was needed. Based on such conditions, the government of the Philippines formulated "the Project for the Improvement of the Health System for the Province of Benguet" for the purpose of upgrading the quality of medical services by improving the health care service system in the province of Benguet by 2003. For implementation of this plan, the government of the Philippines requested Grant Aid from the government of Japan. 1-2 Project Overview The project aimed to enhance the health care delivery system and the referral system in Benguet Province through the construction of a new ward in the Benguet General Hospital, upgrading the medical equipment, and procuring sufficient medical equipment for local hospitals and rural health units. (1) Overall Goal
1) To improve the health conditions of the residents
2) To improve the medical services at local hospitals, the supporting system for rural health units and the referral system at the provincial level
3) To enhance the health care delivery system in the Benguet Province (2) Project Purpose
To establish the referral system by introducing and utilizing adequate medical equipment and facilities and to enable the Benguet General Hospital to provide health care at a core and tertiary medical hospital. (3) Outputs
1) The medical equipment is improved at the Benguet General Hospital, five local hospitals, and 13 rural health units.
2) anew ward is built at the Benguet General Hospital.
3) The advanced medical equipment necessary for the tertiary hospital is provided via the Benguet General Hospital
4) Radio communication devices are installed to strengthen the communication among the Benguet General Hospital, local hospitals, and rural health units. (4) Inputs Japanese side: 380 million yen (FY 1997) 1,240 million yen (FY 1998) 1,168 million yen (FY 1999) Philippines Side: Local Cost 2. 9 million yen Others Land reclamation and infrastructure building such as electricity and water system |
3-1 Summary of Evaluation Results(1) Impact
A referral system was established in the province of Benguet through the project and this has strengthened the medical care delivery system within the province. With the procurement of equipments and the construction of a new wing at Benguet General Hospital, the number of patients has increased from 51,865 in 2000 to 67,160 in 2002 (equivalent to a 29.5% increase). The capacity to admit patients has also increased because there were no particular outbreaks of diseases during this period. With the acquisition of medical equipments required, a referral system has been arranged which resulted in the increase in admittance of transferred patients from 74 in 2000 to 528 in 2002. Although the number of transferred patients from Benguet General Hospital to the National Baguio General Hospital increased from 84 in 2000 to 218 in 2002, this is due to an increase in the number of cases in which essentially high-level laboratory tests were needed. The functioning of the rural health units has improved due to new medical equipment and training of the medical staff through the project. As a result, local residents are now able to receive basic health services at rural health units.
The residents in the province of Benguet appreciate the province’s medical service system. According to a questionnaire survey, which had four response options, (a: extremely effective, b: effective, c: fair, d: not effective), 59.6% of the 74 respondents indicated that the services of the province were effective. This suggests that the satisfaction of the residents led to an increase in the number of outpatients at the Benguet General Hospital. The respondents also indicated that prior to the project, they did not rely on receiving medical services at rural health units and tended to travel to private hospitals in Baguio City instead. Since the rural health units have been provisioned with adequate medical equipment, the respondents began make use of these health units. Residents were able to gain easy access to medical services with good quality at a low price and to some extent, it could be understood that the project has contributed to reducing the burden of medical expenses for the residents.
Various indicators need to be studied for the projects overall goal for “the improvement of the health conditions of the local residents”. It should be noted that there are various factors other than the improvement of the medical system in the province, which would have influenced the improvement of health conditions. Therefore, it was difficult to verify to what extent the project has contributed to the improvement of health conditions in this region from this evaluation study. (2) Sustainability
According to the standards of the National Department of Health, Benguet General Hospital meets the requirements as a tertiary hospital in terms of medical facilities and equipment. However, it can only hold a secondary hospital license since it does not satisfy the required number of personnel; specifically there is a shortage of 60 permanent specialists or medical technicians. Provinces are allowed to hire a specific number of permanent employees based on the Internal Revenue of Allocation, which is provided by the central government to local government. (The IRA is determined by the size of area and the population. Local governmental jurisdiction and regulations stipulate that permanent staff may make up to 45% of the IRA). Since the required number for the entire province has already been filled, Benguet General Hospital is not able to hire any additional permanent staff.
The staff at Benguet General Hospital has increased from 163 in 1999 to 296 at present, but it is still less than the 2003 goal of 323, (which is also the standard according to the regulation set by the Department of Health). As stated earlier, the number of specialist doctors and medical technicians are insufficient as well. To fill this gap, the provincial government of Benguet launched a volunteer program involving medical-related personnel. Benguet General Hospital has 33 volunteer doctors and emergency specialist doctors currently and tries to utilize the facilities as much as possible. The Intensive Care Unit (ICU) and the Coronary Care Unit (CCU), which were not in use at the time of the terminal evaluation of the project, are now being partially used and improvement is significant.
In order to deal with the restriction on employment of permanent staff, the Provincial Council is deliberating on a proposal to place the operation of the Benguet General Hospital under a “semi-public” scheme, with the province maintaining ownership while consigning its operation to the private sector. If this proposal passes in congress, it will become possible for the Benguet General Hospital to exercise the right to decide on the hiring of permanent staff. At the same time, the hospital will be able to receive financial and organizational assistance from the provincial government, including funds for maintenance and management of the hospital.
Training for the staff at Benguet General Hospital, the regional hospitals, and rural health units were conducted continuously, and these contributed to improvement of the level of knowledge and skills in the entire province. In addition, a sister relationship has been established with Saku Central Hospital in Japan and the study tours and technical training in Japan have been carried out. This cooperation also has contributed to improving the technical skills of medical staff at rural health units.
At Benguet General Hospital, those in charge of the medical equipment have been hired and the new equipment was being appropriately maintained and managed using manuals, which were prepared during the project implementation period. However, it often requires time to repair advanced equipment. The main source of revenue of Benguet General Hospital is the annual fiscal budget of 52 million pesos from the provincial government. There has also been an improvement in the hospital’s own income which increased from 7 million pesos in 2000 to 15.8 million pesos in 2002 (an increase of 125.7%). In terms of the government budget, 22. 4% is allocated to the health sector each year and continuous financial assistance from the government is currently taken into account. 3-2 Factors that Promoted the Realization of Effects (1) Factors Concerning the Planning
Since there was already a cooperative system leading by Provincial Department of Health, training and technical cooperation were actively developed by the medical care institutions from province level to municipal level. This has greatly contributed to the realization of the impact of the project. In addition, the sustainability of the project was substantial due to the active participation of the Department of Health and medical-related personnel at the provincial level of the project’s formulation stage. (2) Factors Concerning the Implementation Process
1) The acquired facilities/equipment were appropriate to the functions of the medical institutions and the appropriate training enabled medical staff to carry out their professional duties with confidence. This confidence has brought reliance and comfort to the residents vis-a-vis medical services in the province.
2) The newequipment was appropriate and required no special training. Thus, medical staff could operate it without any problems after completion of the project. 3-3 Factors that Impeded the Realization of Effects (1) Factors Concerning the Planning
N/A (2) Factors Concerning the Implementation Process
Government regulation (IRA) regarding the employment of permanent staff restricted the number of permanent staff employees. To cover those shortages, volunteer doctors and part-time staff were employed. The issue is expected to be resolved by the Philippine side. 3-4 ConclusionThrough the project, a referral system has been put in place and the overall medical services of the province have been enhanced from tertiary hospitals to local hospitals and rural health units. Despite the fact that Benguet General Hospital has the facilities/equipments worthy of a tertiary hospital, its status remains that of a secondary hospital due to an insufficient number of permanent staff, (as regulated by government restrictions). However, the provincial government has been active in assisting the health sector through such activities as launching a volunteer program and devising measures to deal with staff shortages. It is expected to be resolved by the Philippines. 3-5 Recommendations(1) A plan to transform Benguet General Hospital into a semi-public institution is being examined but a detailed analysis of the management structure and financial analysis have not yet been submitted to the provincial legislative council. It is preferable to hold a preliminarily study regarding this issue and to study it carefully. How the new system would affect the residents will also be and important factor in evaluating the relevance of the plan. (2) Presently, a new technical cooperation project, “the Community Health Promotion Project in the Province of Benguet”, is being planned in the same area. The project will aim at improving the regional health system, focusing particularly on maternity health. It is important to study how the results of the project could be linked with the new technical cooperation project, such as utilizing the resources of the rural health units (strengthened by the project) to enhance the regional health system. 3-6 Lessons Learned(1) It is important to have personnel in important positions from the project formulation stage. This would require a commitment of those concerned with the project and would make it possible for the smooth implementation and ultimate sustainability of the project outcome. (2) In this project, provincial health centers and the medical-related personnel participated at the project formulation stage. This could be understood as a factor that contributed to the realization of the impact and sustainability of the project. Therefore, it is necessary and important to involve all personnel concerned with the project from the initial planning stage for the project to be effective. 3-7 Follow-up SituationN/A |
