Posted by: davidjolson | 11/22/2010

Lessons from the Philippines in citizen control of health care

This blog was written by Erin Schiavone of Abt Associates, Inc. in Bethesda, Maryland, where she supports Health Systems 20/20, USAID’s global health project working to strengthen health systems in developing countries.

WASHINGTON, D.C. — Can citizens improve the quality of health care in their community? What mechanisms are necessary to make that change sustainable?

Derick Brinkerhoff addressed these questions at the Global Health Council earlier this month as a part of Health Systems 20/20’s monthly brownbag at the GHC. Over the past year Health Systems 20/20 experimented with a mechanism intended to improve health governance at the facility level in the Philippines by creating a mechanism for citizen input into service delivery decisions. The aim was to increase government responsiveness to public health needs, accountability and citizen voice.

The demonstration activity, implemented through a grant to a local Philippine NGO, the Gerry Rojas Foundation, created Quality Assurance Partnership Committees (QAPC) in three health facilities in two provinces on the island of Mindanao. Committee membership combined facility staff and local citizens to discuss health service delivery issues and jointly find solutions.

The QAPCs contributed  to measurable service delivery and governance improvements: Facility-based births and the uptake of family planning increased, suggestion boxes  improved the health facilities’ response to community needs and facility managers have taken community-raised issues into account in resolving complaints about providers.

Another outcome was citizen empowerment; QAPC community representatives transformed into leaders. Amor Garcia, who Brinkerhoff initially described as a demure housewife, shined as the QAPC president in Compostela Valley. Within six months Garcia was presenting to the governor on the health needs of her community and the activities of the QAPC. “Amor’s increased confidence and pride was visible,” Brinkerhoff said.

Engaging committed community members was challenging since participation in the QAPC required a time commitment and transportation expenses.  This issue was remedied by local officials who included a line item in their 2011 budgets to provide committee members with an honorarium for expenses.

An important factor in the success of the three QAPCs was the commitment of local government officials and the facility staff. Local officials signed executive orders giving QAPCs official recognition. Staff in all three facilities were supportive of community engagement in service quality improvement and an increasing responsiveness to community needs.

Among the other lessons learned from this activity was the importance of community membership criteria. Brinkerhoff emphasized that members need to have a direct link to community members. The QAPC where community participation came from NGO representatives was not as effective in reaching community members as the committees where individual served the community representation function.

Join us Thursday, Dec. 9 for the next Health Systems 20/20 monthly brownbag at the Global Health Council.  See the Health Systems 20/20 for more details.

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