Executive Summary of LEAD Technical Working Document by taoyni

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									           Local Enhancement and Development (LEAD) for Health
                     Management Sciences for Health




               Executive Summary of
               MSH Proposal for LEAD
                                October 15, 2003




This report was made possible through support provided by the U.S. Agency for
International Development (USAID) under the terms of Contract No. 492-C-00-03-
00024-00. The opinions expressed herein are those of the author(s) and do not
necessarily reflect the views of USAID.




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Executive Summary

LEAD offers a unique opportunity to make a lasting difference in the Philippines, to help
slow population growth, reduce the burden of tuberculosis and HIV/AIDS, and make a
better life for future generations of Filipinos. We believe that this proposal, submitted by
MSH and its partners, combines a vision of what is possible with the concrete steps
needed to turn that vision into reality.

MSH has implemented five major health projects in the Philippines since 1990. Each
project had different leadership and different key staff but built upon earlier successes.
During those 13 years, we have learned a great deal about what works and what does not.
We recognize that LEAD must be implemented in a radically different milieu and that
what might have made perfect sense five (or even two) years ago may not make sense
today. Perhaps the most cogent example is that of family planning: many interventions in
support of family planning in the Philippines over the past 30 years were somewhat
effective at the time they were introduced, but they can no longer meet the challenges of
the Philippines of 2003. We need fresh ideas and new approaches.

There has indeed been a paradigm shift in family planning and other health services:

   The locus of power and responsibility for delivery of key social services (like family
    planning or Tb-DOTS) has shifted from the national to the LGU level as devolution
    has taken hold over the past decade. The “client” is no longer the DOH—it is the
    LGU, the private providers, and the community.
   It is no longer enough to work with municipal health officers, nurses, and midwives
    to improve service delivery and make certain that the poor have access to quality
    care. We must now focus on collaborating with mayors and barangay captains, and
    with other sectors besides health, to generate the grassroots commitment that alone
    can lead to sustainable programs
   The public sector is no longer dominant. It still has an important role to play in
    developing and maintaining standards and assuring quality, as well as in guaranteeing
    that the poor have access to critical services. But it is the private sector that now must
    provide services for the majority who can afford to pay. Free contraceptives are no
    longer tenable.

To achieve the ambitious LEAD objectives in this new environment, we must draw on
the learnings of earlier projects and then move rapidly forward with new initiatives. MSH
and its partners—ARD, Save the Children, the Harvard School of Public Health,
JHPIEGO, Technical Assistance, Inc., the Manoff Group, and CEPR—are prepared to
move quickly to carry out the Project components and tasks. We will be able to begin
immediately to establish a functioning network of at least 400 LGUs. This will be
possible in part because of strong relationships with LGUs in MSH’s most recent
projects, both of which have had all-Filipino professional staff. PMTAT enabled us to
work to strengthen the capacity of 414 LGUs to manage family planning and child health
programs; HSRTAP supported major health reform initiatives in 60 LGUs. Equally
valuable will be the linkages and insights contributed by our partners, particularly Save



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the Children, through its exceptional community-based programs in Mindanao and other
challenging Philippine settings, and ARD, through its highly acclaimed work with LGUs
on the GOLD and LDAP projects in stimulating effective local management of
multisectoral projects. The MSH team will also work very closely with the Leagues of
Cities and Municipalities, which will serve as subcontractors and provide key links with
the LGUs.

MSH and its partners have slowly and gradually established productive relationships with
LGU officials over many years, as mutual trust has developed. Any organization coming
new to the LGUs would need time to master the procedures for transferring funds,
negotiating memoranda of agreement, and other administrative functions. But even more
important, a new organization would have to devote considerable time and effort to
developing the mutually trusting relationships so crucial for any program to succeed in
the Philippines.

MSH and its partners have also established very close working relationships over the
years with senior policymakers at the national level, in the DOH, and at PhilHealth. Any
high-impact, sustainable idea generated from one LGU will be able to be rolled out very
quickly to other LGUs around the country (as has occurred with no-scalpel vasectomy
and local disease surveillance over the past 18 months).

Our strategies for LEAD begin with public policy and focus on five themes that will
achieve all project objectives synergistically:

      Aligning public policy with the aspirations of Filipino couples for smaller,
       healthier families, and with slower population growth to protect the environment
       and to secure gains of economic development, as have other neighboring nations;
      Increasing coverage for family planning and TB-DOTS services. Our proposal
       identifies a number of important ways that coverage can and will be greatly
       expanded, with a special emphasis on Mindanao;
      LGU market transformation, so that those who can afford to pay for FP and
       TB-DOTS will actually do so through the private sector, and those who cannot
       afford these services will be supported by the LGUs;
      Increasing membership in the National Health Insurance Program by
       including the indigent, followed by other segments of the population;
      Community-based activities that will greatly increase the effectiveness of
       Barangay Health Workers and other community workers and volunteers;
      Changing provider behavior so that the quality of health services (especially
       family planning and TB-DOTS) will be greatly improved.

The time is right for implementation of LEAD in the Philippines. MSH and its partners
bring a commitment to excellence and innovation while building on the best of what has
been accomplished in the past. This combination of new ideas, a vast network of
relationships with LGUs throughout the country, an outstanding team, and partner
organizations with a track record of successful projects in the Philippines, represents
what is needed to make LEAD a watershed in the changing Philippine environment.



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