The Birth of Sentrong Sigla

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• The Birth of Sentrong Sigla

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Quality Assurance Program (QAP)

• Goal To make DOH and LGUs active
• partners in providing quality
  health services
• Key Strategies
• (1) Certification/Recognition Program - CRP
• (2) Continuous Quality Improvement - CQI

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Sentrong Sigla Movement

• Goal QUALITY HEALTH
• Objective Better and more effective
• collaboration between
  DOH
• and LGUs
• DOH as provider of technical and
• financial assistance packages for
  health care
• LGU prime developers of health
• systems and direct implementers of health
  programs

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Sentrong Sigla Movement

• Pillars ? quality assurance
• ? grants and technical assistance
• ? awards
• ? health promotion
• Phase Period Standards
• I 1998-2000 input
• II 2001-2004 process
• III 2005-2010 outcome or
• 
  impact

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Achievements of SS

• SS-Certified as of end of 2003
• ? 53 of health centers
• ? 15 of district and provincial hospital
• ? 3 of BHSs
• ? Additional awards for several facilities
• Total amounts of awards given Php 135.0 M

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Positive Outcome of SS

• created a quality service-orientation among
  public health service providers
• promoted interest and participation of LGUs in
  raising quality health services
• generated additional support from LCEs for
  health channeled local resources to fund
  supplies, basic, equipment of facilities

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Positive Outcome of SS (cont)

• improved quality of services in general
  changed attitudes of service providers perceived
  increased utilization of services
• effective tool to maintain DOH leadership in
  health that would ultimately redound to health
  impact
• several health centers received CQI training
  some established quality circles

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Valuable Lessons

• realization to the need for total systems
  quality standards that combine simple yet basic
  input, process and output standards
• importance of careful selection of incentives
• the need for changing procedures to provide
  adequate time for crucial processes to take place
  and be internalized prior to the assessment

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• The Sentrong Sigla Certification
• (SSC) Phase II

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Background/Framework

• efforts to raise quality of health services to
  be intensified
• expansion of concern on quality beyond DOH-LGU
  interaction to the entire health sector
• to be coordinated by a multi-sectoral Quality
  Health Care Committee

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Quality in Health Framework
R E S E A R C H and T R A I N I N G
D A T A E V A L U A T I O N
hospitals
laboratories
Outpatient clinics
Suppliers to providers
Traditional healers and non-prof providers
A D V O C A C Y
Licensing to ensure basic safety
Accreditation/certification to stimulate
continuous quality improvement
Initial Phase externally enforced regulations
and standards with periodic
evaluation of
compliance Later Phase self-regulation and
self determination
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Guiding Principles

• recognition of achieving quality the main
  incentive in SS certification
• quality improvement is an unending process
• certification to focus on public health
  programs proven most cost-beneficial to the
  people
• quality improvement is a partnership that
  empowers all stakeholders

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Guiding Principles (cont)

• roles and responsibilities including
  contributions must promote appropriate
  counterpart and reciprocity
• purposive DOH assistance
• involvement of non-DOH partners to ensure
  objectivity and broader perspective

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Goals

• Long Term institutionalize within the health
  sector the leadership, processes, knowledge,
  attitudes, skills and organizations to generate
  continuous quality improvement in health care
• Intermediate (2003-07) to improve quality of
  health care in outpatient health facilities,
  hospitals and public health services in the
  communities
• Specific to improve the quality of out-patient
  health care (public and private) and of public
  health services in communities

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Objectives

• (1) To establish an efficient system of
• ? providing technical and other forms of
  assistance to the LGUs
• ? assessing health services against
• established standards
• ? monitoring key indicators in the SS
  Certification process

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Objectives (cont)

• (2) To progressively raise the average quality of
  public health services through recognition of
  successful attainment of quality standards
• at least 50 of health centers successfully
  meet the revised SS-Phase II Basic Certification
  Standards (Level 1)
• at least 20 of Level I certified health
  centers successfully meet SS-Phase II
• Specialty Award (Level 2) standards for all
  core public health programs

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Objectives (cont)

• (3) To raise public health
• awareness of public support
• and demand for, and client
• participation in SS Certification
• of their health services and
• facilities

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Level and Scope of the
Certification

• Level Category Description
• I Basic SS minimum input, processes and
• Certification output standards for
  integrated
• public health services for 4 core
• programs, facility systems,
• regulatory functions and basic curative
  services
• II Specialty Award second level quality
  standards
• for selected core public health
• programs
• III Award for highest level quality
  standards for
• Excellence maintaining Level 2 standards
  for
• the 4 core public health
• programs and Level 2 facility systems
  for at least 3 consecutive years

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Recognition Scheme

• Level Recognition Given by
• I SS Seal, individual CHD
• recognition
• II Specialty Banner, CHD
• individual recognition
• others
• III SS trophy, individual
• National recognition, media
• exposure, others

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Validity of Certification

• (1) facilities which did not progress to a higher
  level of certification but maintained current
  certification are
• - given stickers to confirm the renewal of
• the validity of seal
• - no other incentives given for mere
• renewal of SS status
• (2) facilities that slide back seal will not be
  removed but not issued a SS sticker

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CHD orients LGUs and distributes QSL
DOH Rep visits LGU prepare for self-assessment
LGU conducts self-assessment (DOH Rep
facilitating)
LGU makes plan how to meet SS
DOH Rep makes TA Plan with CHD
LCE provides local support
DOH Rep/TA Team provides TA packages
LGU implemented plan and ready for assessment
DOH Rep schedules assessment
LGU did not pass assessment
Assessors conduct assessment
LGU passed assessment
CHD certifies LGU
SL No. 1.4.9 Process in the Provision of TA
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Similarities

• ultimate aim - to improve quality of health
  services
• certification/recognition and continuous
  quality improvement remain as key strategies
• continue as a partnership with LGUs
• regions remain as overall in-charge of
  certification of health facilities
• CHD TA Teams to provide assistance
• LGU participation is voluntary

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Differences

• standards include input, process, outcome
• standards cover health facility and systems, 4
  core public health programs, basic curative
  services and regulatory function
• covers initially only RHUs/Health Centers to
  expand to BHSs, private clinics and
  community-based facilities hospitals not covered
• minimal cash awards

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Differences (cont.)

• no prequalification based on inputs
• all standards, tools in assessment to be
  transparent
• purposive TA to be provided
• TA Packages to be disseminated
• LGU self-assessment assisted/facilitated by the
  DOH Reps
• training of TA Teams and Assessors