GUIDELINES FOR THE ADOPTION OF MORE EFFICIENT AND EFFECTIVE DEVELOPMENT APPROVAL, AND IMPLEMENTATION OF PIPH/AOP UNDER FOURMULA ONE FOR HEALTH

The nationwide rollout of implementation of FOURmula One (F1) to 81
F1 sites requires a more efficient process for development, approval and
implementation of Province-wide Investment Plans for Health (PIPH) and
its Annual Operational Plans (AOP). Fast tracking F1 reforms under a
Sectoral Development Approach (SDAH) for Health will accelerate
achievement of Millennium Development Goals (MDG) in the country.

Resources and energies for F1 must be maximized. Various procedural
delays experienced in the development, approval and implementation of
PIPH and AOPs in the country must be addressed. Specific areas for
improvement are seen in (i) Complex and confusing instructions and
guidelines for PIPH development, (ii) very centralized management of
processes from DOH Central Office and SDAH partners, (iii) duplication
of transactions for approving AOP and SLA, (iv) repetitive review
process at various levels, and (v) low fund utilization of (40-50%)
emanating from various delays and many restrictions on the release of
funds for Province-wide Health Systems (PWHS) to initiate implementation
of their PIPH.

II. OBJECTIVES

General Objective:

This Administrative Order seeks to provide guidelines for
improving procedural efficiency relevant to development, approval and
implementation of the F1 PIPH and AOP

Specific Objectives:

1. Reduce duration of procedures involved
2. Omit duplication of functions and procedures
3. Delineate specific purpose, roles and functions for all relevant stakeholders

III. KEY PRINCIPLES & STRATEGIES

1. Streamlining of Process Flows to simplify and shorten
the process of submission and approval of documents and facilitate the
release of funds for reform implementation.
2. Empowerment of the CHD as a Major F1 Player by giving them a more active role in the appraisal of the PIPH and AOP.

3. Enhancement of Joint Appraisal Committee (JAC) Review
with a more focused format that facilitates substantive application of
JAC resources on PIPH/AOPs of local government partners.

IV. SCOPE AND COVERAGE

This Order shall apply to all bureaus, national centers, services and
CHDs of the DOH. This shall also serve as a guideline for LGUs and ARMM
with respect to the provision of the Memoranda of Agreement (MOAs) that
has been consummated for purposes of the PIPH/AIPH. This shall also be
binding upon members of the Joint Appraisal Committee (JAC), pursuant to
the implementation of the Sectoral Development Approach for Health
(SDAH). It shall also cover all transactions related with PIPH/AIPH
development and implementation.

V. DEFINITION OF TERMS

1. F1 – FOURmula One for Health – a
strategic framework for health reforms formulated by DOH using four
pillars (Service Delivery, Health Care Financing, Health Governance and
Health Regulation) in attaining the National Objectives for Health and
the Millennium Development Goals for Health.

2. F1 Sites – provinces or highly urbanized cities considered as implementation sites for F1 for Health.

3. MDG – UN Millennium Development Goals – worldwide
effort to attain the following goals by 2015: alleviate extreme
poverty and hunger; achieve universal primary education; promote gender
equality & empower women; improve maternal health; reduce infant
mortality; combat HIV/AIDS, Malaria, TB, Filariasis, etc; ensure
environmental sustainability; and develop a global partnership for
development.

4. PIPH – Provincial-wide Investment Plan for Health
– a five-year medium term plan prepared by F1 convergence provinces
using the FOURmula ONE for Health framework to improve the highly
decentralized system: financing, regulation, good governance and service
delivery.

5. AOP – Annual Operation Plan – specifies program
activities for the year including activities covered by Service Level
Agreement, within the annual investment cost – as reflected in the
five-year PIPH for all sources of funds (i.e. PLGU, MLGU, Development
Partners Support, DOH budget support, PHIC, etc.)

6. JAC – Joint Appraisal Committee – a committee
headed by the DOH Secretary, DOH Sectoral Management Cluster Head and
PhilHealth President as co-chair; and the heads of the DOH National
Centers and all government agencies involved in health programs as well
as representatives from development partners as members. The committee
appraise the PIPH before it is endorse to the development partners for
funding, it also provides guidance and recommends appropriate action for
investment planning in health reforms.

7. SDAH – Sectoral Development Approach for Heal th
– a way of organizing the planning and management of international and
national support for health reform under the Fourmula One framework. It
aims to eventually involve all Partners supporting the Health Sector.

8. SLA – Service Level Agreement – a signed
agreement between the DOH and each of the F1 sites that defines the
outputs and milestones to be reached, the amount of funds to be provided
through a grant from ODA Partners and the DOH’s counterpart
contributions and requirements pertaining to the release of said funds.

9. MOA – Memorandum of Agreement – a signed
agreement between the DOH and each of the F1 sites that formalize the
collaboration in the implementation of the PIPH and to define the
general roles and responsibilities of each of the two parties including
financing support from DOH.

10. CHD – Center for Health Development – the regional office of DOH headed by the Regional Director.

11. PWHS – Provincial Wide Health System – a devolved health system headed by the Provincial Governor.

12. Primary TA Provider – Primary Technical
Assistance Provider refers to a team or individual with technical
expertise provided by Health Partners to assist the CHDs in the
development and appraisal of PIPH and AOPs including the presentation of
the plan appraisal report for JAC review.

13. MNCHN – Integrated Maternal, Neonatal, Child
Health and Nutrition Strategy – this is a F1 Health approach that
outlines the specific policies and actions for local health systems to
systematically address health risk that lead to maternal and neonatal
deaths.

V. GENERAL GUIDELINES

A. Development and appraisal of PIPHs and AOPs will be in accordance
with existing guidelines, subject to revisions and focal themes provided
for in this issuance.

B. The Service Level Agreement (SLA) and the Annual Operational Plan
(AOP) for 2009 shall be processed and integrated as one document. The
CHDs shall also be responsible for approval of agreements on the AOPs.
The Secretary of Health will approve the Memoranda of Agreement for all
PIPHs.

C. Detailed appraisal of new PIPHs and of all AOPs shall be delegated to CHDs.

D. JAC Review of PIPH/AOPs will focus on health outcome results
orientation, impact on poor population, and matching plans with
available funds.

E. Key local government officials will present their PIPH while key
officials of the CHDs will present the AOPs to the JAC. Primary TA
providers assigned to the CHD will assist in the appraisal and
presentation of PIPHs/AOPs.

F. JAC Review recommendations will serve to enrich PIPHs/AOPs
reviewed. The JAC recommendation shall not be cause to hold back
immediate implementation of PIPHs/ AOPs, specifically those initiatives
funded by the LGU counterpart.

VI. SPECIFIC GUIDELINES

A. Development and Appraisal of PIPH

1. PIPH development and appraisal shall give particular care to the following:

a. Better participation of municipalities, NGOs, private
providers, peoples organizations and client/consumers in the planning
process.
b. Setting goals based on ME3 and objectives based on LGU Scorecard parameters
c. Reform interventions including the following:

– Service Delivery: Public-Private Partnerships (e.g. for TB-DOTS, for CSR & for Health Facility Development, etc.)
– Regulation: Botika ng Barangay
– Financing: Identification and enrollment of poor in PhilHealth,
Increasing local Budgets for health and Extra-budgetary financing
sources
– Governance: ILHZ formation, Development of Human Resource for Health, Health Information System Development

2. AOP development, appraisal and implementation shall give particular care to the following:

a. By May 2009:

Public-Private Partnerships, interventions to benefit the poor
and Geographically Isolated and Disadvantaged Areas (GIDA), MNCHN
operations, and municipal & city level investment planning

b. By August 2009

Hospitals and Facilities, Drugs and Pharmaceuticals, human
resources, province-wide financial guidelines governing multiple sources
of funds for PIPH/AOP implementation

c. Utilization of LGU Scorecard Indicators in Situational Assessment, and for planning intervention for PPAs in AOP

d. CHD issuance of clearances on matters concerning technical
specifications and program standards arising from the PPMP based on
comparisons with technical specifications and program standards, as
stipulated the DOH website. The CHDs shall refer the requests for
clearances to the appropriate DOH Central Office unit in cases when
technical specification and program standards are not provided for in
the DOH website.

e. Infrastructure upgrade must be consistent with
Rationalization Plan if available, or focused on Provincial Hospitals,
Core Referral Hospitals of functional ILHZ and Primary Care Facilities
(RHUs, Health Centers, BHS) while Rationalization Plan is not completed

f. Matching Fund requirements with available funds from all sources

3. CHDs shall be accountable for the detailed appraisal of the
PIPH/AOPs and for ensuring readiness of plan for submission for JAC
review. It shall be the responsibility of the CHD Director to ensure
consistency of the SLA and the AOP of the province with the PIPH and the
corresponding MOA signed by the Secretary of Health. The DOH, through
the respective CHD, and the Provincial Governor shall concur the AOP
in writing, with the Provincial Health Officer, and the Assistant
Regional Director, being the PIPH point persons shall sign as
witnesses.

4. Primary TA providers assigned to CHDs shall assist CHDs and LGUs
in developing plans, appraising completed plans, and presenting plans
for JAC review.

5. PIPH appraisal will be according to the guidelines found in DM
No. 2008-0006 (Adoption of the PIPH Appraisal Tool for the Assessment of
the PIPH of the Roll-out Convergence Provinces, January 4, 2008).

6. AOP appraisal will be according to DM No. 2009-0027 (Utilization
of the Appraisal Tool in the Review of the 2009 Annual Operational Plan
(AOP) in the FOURmula One (F1) Pilot and Roll-out Sites and Other Provinces, January 27, 2009).

B. Integration of SLA and AOP

1. Upon approval and validation of new PIPHs for the nationwide
roll-out provinces, CHDs shall immediately coordinate with LGUs in the
drafting of the SLA for 2009 alongside the LGUs formulation of the AOP
2009 and its sub-plans.

2. CHDs shall be guided below with the status of 2009 AOP
development and how this will be synchronized with the preparation and
approval of the 2009 SLA:

Status of Development		Required Support from CHD
A. Provinces who have already submitted to the DOH-Central Office but without SLA		– Consultation with concerned provinces their 2009 AOP re: 2009 SLA vis-a-vis 2009 AOP – Facilitate the signing of the 2009 SLA and submission of said document to the DOH-Central Office through FIMO
B. Provinces whose 2009 AOP are still with the CHD for review and without SLA		– Check for consistency and completeness of both documents (2009 SLA and 2009 AOP)
C. For those provinces whose AOP are still in the LGUs for finalization and without SLA		– Consultation with concerned provinces re: 2009 SLA vis-a-vis 2009 AOP – Facilitate the preparation and signing of the 2009 SLA and AOP and submission of same to DOH-Central Office through FIMO

3. Parties to the SLA shall be the CHDs on behalf of the DOH, and
the LCEs on behalf of the provinces. The CHD Director IV and the
Provincial Governor shall be the respective signatories. The CHD
Director III, Provincial Health Officer II, and the OIC of the DOH
Accounting Division shall sign as witnesses (Annex A)^[*]

4. The SLA shall be based in part on fund ceilings computed by the
DOH Central Office and Foreign Assistance Providers (FAPs), while the
AOP shall be based on the PIPH (Annex B)^[*].

C. Streamlined JAC Review

1. The JAC will have access to all copies of the PIPH an AOPs
through a web portal where all PIPHs/AOPs submitted for JAC review will
be uploaded. The BLHD, with the assistance of the IMS shall upload
electronic copies of all submitted AOPs and Appraisal Reports to a
secure online portal with access controls restricted to the JAC and the
JAC Technical Secretariat.

2. The JAC shall be convened to review and enhance the plans of
LGUs with its technical and financial resources, on the premises of CHDs
having completed detailed appraisal of the PIPH/AOP submitted for
review.

The JAC Review shall:

a. Focus review on the orientation of plans on (i) Results,
(ii) the poor, (iii) and on appropriate fund ceilings for each specific
fund source
b. Consist of the following structure:

1. A situationer of trends in F1 results, investments, and status of PIPH/AOP development in the country
2. CHD presentation of appraisal report and highlights of
content of AOPs in the province, based on the focus orientation of the
JAC
3. Local government presentation of its PIPH highlighting focus orientation of the JAC
4. Discussion with JAC members on recommendations on plans presented

3. The JAC recommendations shall not intend to hold back release
of funds nor to hold back LGUs from initiating implementation of
PIPHs/AOPs. The comments and recommendations of the JAC shall apply
enhancement through measures which may include, but are not limited to
the following categories:

a. Recommendations for improvement of the plan that will be
delegated to CHDs and its primary TA provider, to oversee application of
enhancements to 2009 plans when possible, but certainly to enhance 2010 plans submitted for JAC review.
b. Components of the plan that will not be funded by DOH or ODA
partners, and as such would necessitate adequate budget allocation from
the LGU.

4. The JAC shall ensure the proper facilitation of financing
agreements. It shall recommend appropriate financing sources for
activities in the PIPHs/AOPs, in consideration of fund availability and
fund sources.

VII. SEPARABILITY CLAUSE

In the event that any provision or part hereof is declared
unauthorized or rendered invalid by any court or competent authority,
those provision that are not affected by such declaration shall remain
valid and effective.

VIII. REPEALING CLAUSE

Provision from previous issuances that are inconsistent or contrary
to the provisions of this Order are hereby rescinded and modified
accordingly.

IX. EFFECTIVITY

This Order shall take effect immediately.

Adopted: 12 March 2009

(SGD.) FRANCISCO T. DUQUE, III MD, MSc
Secretary of Health

^[*] Text Available at Office of the National Administrative Register, U.P. Law Complex, Diliman, Quezon City.