The Philippines Field Management Training Program (FMTP): strengthening management capacity in a decentralized public health system

Sucaldito, Nemia L.; Tayag, Enrique; Roces, Maria Concepcion; Malison, Michael D.; Robie, Brian D.; Howze, Elizabeth H.

doi:10.1007/s00038-014-0603-5

Cited by 13 publications

(12 citation statements)

References 7 publications

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“…Without such conditionalities, local governments may become constantly dependent on the national government for its health workforce needs. Other accountability mechanisms may include the national/central level taking responsibility for building the capacity of local government health workers across the country [58], as well as implementing a national policy that discourages local health workers from being partisan during local elections in order to insulate them from politicisation.…”

Section: Resultsmentioning

confidence: 99%

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

Liwanag

Wyss

2019

Health Res Policy Sys

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BackgroundSeveral studies on decentralisation have used the ‘decision space’ approach to assess the breadth of space made available to decision-makers at lower levels of the health system. However, in order to better understand how decentralisation becomes effective for the health sector, analysis should go beyond assessing decision space and include the dimensions of capacity and accountability. Building on Bossert’s earlier work on the synergy of these dimensions, we analysed decision-making in the Philippines where governmental health services have been devolved to local governments since 1992.MethodsUsing a qualitative research design, we interviewed 27 key decision-makers at different levels of the Philippine health system and representing various local settings. We explored their perspectives on decision space, capacities and accountability in the health sector functions of planning, financing and budget allocation, programme implementation and service delivery, management of facilities, equipment and supplies, health workforce management, and data monitoring and utilisation. Analysis followed the Framework Method.ResultsAcross all functions, decision space for local decision-makers was assessed to be moderate or narrow despite 25 years of devolution. To improve decision-making in these functions, adjustments in local capacities should include, at the individual level, skills for strategic planning, management, priority-setting, evidence-informed policy-making and innovation in service delivery. At institutional levels, these desired capacities should include having a multi-stakeholder approach, generating revenues from local sources, partnering with the private sector and facilitating cooperation between local health facilities. On the other hand, adjustments in accountability should focus on the various mechanisms that can be enforced by the central level, not only to build the desired capacities and augment the inadequacies at local levels, but also to incentivise success and regulate failure by the local governments in performing the functions transferred to them.ConclusionTo optimise decentralisation for the health sector, widening decision spaces for local decision-makers must be accompanied by the corresponding adjustments in capacities and accountability for promoting good decision-making at lower levels in the decentralised functions. Analysing the health system through the lens of this synergy is useful for exploring concrete policy adjustments in the Philippines as well as in other settings.Electronic supplementary materialThe online version of this article (10.1186/s12961-018-0402-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

Liwanag

Wyss

2019

Health Res Policy Sys

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“…With assistance from multi-lateral development organizations such as the World Bank, WHO, and USAID [ 22 ], the national government transferred the responsibility for government health services and other non-health services (e.g. agriculture) to Local Government Units (LGUs) across the archipelago [ 22 – 30 ]. Currently, the Philippines is organized into 17 regions for the purpose of coordination, although real political power at local levels lies with the LGUs that number into 81 provinces, and the 1,490 municipalities and 145 cities that are geographically within these provinces.…”

Section: Introductionmentioning

confidence: 99%

“…In the aspect of financing, municipalities, unlike the wealthier cities, continued to rely on the income from the national government for health spending [ 26 ]. Moreover, the lack of readiness at local levels prompted the national government to provide a training program in management for local decision-makers [ 30 ], and to deploy centrally-hired health professionals to municipalities that have no resources to hire them [ 33 ]. One paper on the malaria control program described poor implementation at local levels due to dysfunctional linking with the national level [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines

Liwanag

Wyss

2018

PLoS ONE

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BackgroundDecentralization is promoted as a strategy to improve health system performance by bringing decision-making closer to service delivery. Some studies have investigated if decentralization actually improves the health system. However, few have explored the conditions that enable it to be effective. To determine these conditions, we have analyzed the perspectives of decision-makers in the Philippines where devolution, one form of decentralization, was introduced 25 years ago.MethodsDrawing from the “decision space” approach, we interviewed 27 decision-makers with an average of 23.6 years of working across different levels of the Philippine government health sector and representing various local settings. Qualitative analysis followed the “Framework Method.” Conditions that either enable or hinder the effectiveness of decentralization were identified by exploring decision-making in five health sector functions.ResultsThese conditions include: for planning, having a multi-stakeholder approach and monitoring implementation; for financing and budget allocation, capacities to raise revenues at local levels and pooling of funds at central level; for resource management, having a central level capable of augmenting resource needs at local levels and a good working relationship between the local health officer and the elected local official; for program implementation and service delivery, promoting innovation at local levels while maintaining fidelity to national objectives; and for monitoring and data management, a central level capable of ensuring that data collection from local levels is performed in a timely and accurate manner.ConclusionsThe Philippine experience suggests that decentralization is a long and complex journey and not an automatic solution for enhancing service delivery. The role of the central decision-maker (e.g. Ministry of Health) remains important to assist local levels unable to perform their functions well. It is policy-relevant to analyze the conditions that make decentralization work and the optimal combination of decentralized and centralized functions that enhance the health system.

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“…Although management has been recognized as fundamental to health worker performance and motivation, [14][15][16] peer-reviewed studies on management, including quality improvement efforts, in global health are limited in their size, scope, and rigor. About 2 dozen studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] including a literature review 38 have examined the link between management and health system performance in low-and middle-income settings in the last 20 years. These studies are largely uniform in their findings, demonstrating that interventions to build management capacity in facilities and district health teams can influence performance.…”

mentioning

confidence: 99%

“…For instance, one study 21 shows improvements in tuberculosis (TB) case detection rates, patient adherence to TB medication regimens, specimen quality, supply stock outs and timely deliveries. Other studies have documented 22,28,[32][33][34][35] improvements in live birth registrations, percentage of fully immunized children, improved medical records, enhanced infection prevention procedures, clinical guideline adherence, and reduced emergency room and cardiac catheterization waiting time. Although this research is helpful, most studies include data related only to a single organization or district and employ pre-post interventional designs without a comparison to nonintervention sites, with limited statistical analysis.…”

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confidence: 99%

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

Bradley

Taylor

Cuellar

2015

Int J Health Policy Manag

101

123

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Despite a renewed focus in the field of global health on strengthening health systems, inadequate attention has been directed to a key ingredient of high-performing health systems: management. We aimed to develop the argument that management -defined here as the process of achieving predetermined objectives through human, financial, and technical resources -is a cross-cutting function necessary for success in all World Health Organization (WHO) building blocks of health systems strengthening. Management within health systems is particularly critical in low-income settings where the efficient use of scarce resources is paramount to attaining health goals. More generally, investments in management capacity may be viewed as a key leverage point in grand strategy, as strong management enables the achievement of large ends with limited means. We also sought to delineate a set of core competencies and identify key roles to be targeted for management capacity building efforts. Several effective examples of management interventions have been described in the research literature. Together, the existing evidence underscores the importance of country ownership of management capacity building efforts, which often challenge the status quo and thus need country leadership to sustain despite inevitable friction. The literature also recognizes that management capacity efforts, as a key ingredient of effective systems change, take time to embed, as new protocols and ways of working become habitual and integrated as standard operating procedures. Despite these challenges, the field of health management as part of global health system strengthening efforts holds promise as a fundamental leverage point for achieving health system performance goals with existing human, technical, and financial resources. The evidence base consistently supports the role of management in performance improvement but would benefit from additional research with improved methodological rigor and longer-time horizon investigations. Meanwhile, greater emphasis on management as a critical element of global health efforts may open new and sustainable avenues for advancing health systems performance.

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The Philippines Field Management Training Program (FMTP): strengthening management capacity in a decentralized public health system

Abstract: The results provide compelling evidence that managers are using the skills learned to solve significant managerial problems.

Cited by 13 publications

References 7 publications

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

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