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8 provinces will be selected for ZFF PLGP Cycle 2.
Coaches:
Bridging Leadership Coaches: Prof. Ernesto Garilao and Prof. Ynna Teves
Technical Coaches: Dr. Juanito Taleon, Dr. Jennifer Coritico, Dr. Zhamir Umag and Dr. Reynaldo Joson
As a technical coach, I will most likely handle 2 provinces, probably Aklan and Agusan del Sur. Aklan, because I may know Governor Miraflores (I remember I had a patient with a same surname who was in government service) Also, Dr. Leslie Ann Luces from Aklan early this year had contacted me for assistance in Aklan. Agusan del Sur, recommended by Dr. Angeli Comia.
PLGP Cycle 2 Objectives (as copied from ZFF document):
Objectives
General Objectives
1. Best possible health for Filipinos, particularly the poor, through improvement of province-wide health system (under the leadership of the Governor)
2. Bridging leadership formation for governors and leaders of the province-wide health system
Specific Objectives
At the end of the program, the following must be achieved:
1. Increase bridging leadership competencies of governors and provincial health officers
2. Implement and monitor strategies to address maternal mortality, malnutrition and 1 other health priority of engaged province, with particular attention to the poor
3. Implement and monitor strategies to provide WASH at homes and schools, K to 12 education, and address 1 other prioritized social determinants of health, with particular attention to the poor
4. Establish the provincial health system to be a learning system for health equity
As a technical coach, my main role is to facilitate the accomplishment of the following:
Implement and monitor strategies to address maternal mortality, malnutrition and 1 other health priority of engaged province, with particular attention to the poor.
Implement and monitor strategies to provide WASH at homes and schools, K to 12 education, and address 1 other prioritized social determinants of health, with particular attention to the poor.
Establish the provincial health system to be a learning system for health equity. (most likely, have to verify with ZFF organizers)
PBLI (Problem-based Learning Issues):
"attention to the poor" - NHTS-PR and others
"WASH" - Water, Sanitation and Hygiene
"1 other prioritized social determinants of health" - up to the governor and his team
"learning system for health equity" - How do we evaluate this?
Approach (as copied from ZFF document):
Bridging leadership and primary healthcare are two approaches that aim to address health inequities.
Primary healthcare gives input on the key elements of an equitable health system while bridging leadership offers a framework on how to set-up this complex system and make it sustainable.
Primary Health Care
The program will touch on the 5 key elements of primary health care through the enumerated strategies. These strategies are by no means sufficient by themselves to attain the desired aspirations of primary health care. They are however believed to contribute significantly towards that end and are possible to be set-up within the 16 month duration of the program.
PBLI:
Activities in the lower row under the Bridging Leadership - clarify - expound - identify role of coach in the various boxes
Reconcile with Alma Ata PHC
ZFF 5 key elements PHC- strageties - clarify - expound -identify role of coach in the various strategies
Scope
Health Burden
Health burden of the following will be assessed by the province to come up with evidence-based prioritization and ensure that strategies will not compromise the other sectors. The province may expand the scope depending on their local context.
Social Determinants of Health
The following social determinants of health will be assessed by the province to come up with evidence-based prioritization. As the program will only run for around 16 months, the aim is to concentrate on the material circumstances (living and working conditions) given its close relationship to health, legal identity to ensure access to government services, and education as the K to 12 is already a well-structured program with far reaching benefits. The province may expand the scope depending on their local context.
PBLI:
Reconcile with the following objectives:
Implement and monitor strategies to address maternal mortality, malnutrition and 1 other health priority of engaged province, with particular attention to the poor.
Implement and monitor strategies to provide WASH at homes and schools, K to 12 education, and address 1 other prioritized social determinants of health, with particular attention to the poor.
Establish the provincial health system to be a learning system for health equity.
Program Activities:
Initial Data Gathering on the Targetted Province
M-1: ESG - Executive Session for Governor - BL Coach:
BL and Theory U
Current health reality
Visioning
Leadership Journey
Leadership Capital
Health systems and PHC (technical input)
PLGP: similar input as in Governors for Health + relevant roadmaps
SDN: similar input as in Governors for Health + SDN roadmap
Deep dive activity
M-2: Coaching 1 - BL Coach / Technical Coach?
processing of deep dive experience
baseline BL competencies
BL competency inputs on engaging stakeholders (stakeholders analysis and dialogue)
the two above is towards refining vision and creating guiding coalition/core group
Gather additional needed data
Establish Health Information System
Prioritize what needs to be done
Choose relevant indicators to measure progress and success
Create strategy
Dialogue with stakeholders:
1. Vetting of plans
2. Clarify roles
3. Agree on KPIs
Governor:
Mobilize resources and ensure progress
M-3:
Create core group
Refine vision
Translate vision to concrete steps in the following areas
o Health governance including political interventions
o Information system
o SDN (guaranteed and integrated health services)
o Financing
o Sustainable health human resource development and augmentation
o Demand generation
o SDH
Decide indicators to use
M-4:
Convene stakeholders
Communicate vision
Dialogue with core group and other stakeholders
o come up with a shared vision and mission
o support V&M with concrete plan of actions (Health governance including political interventions; Information system; SDN; Financing; Sustainable health human resource development and augmentation; Demand generation; SDH)
o agree on measurable indicators of progress/success
Coaching 2
Technical coach / RD: Input on priorities, plans, indicators, KPIs, monitoring tools
M-5:
Implementation
Operationalize the plans on at least the following:
Health governance including political interventions
o Provincial, district, hospital, municipal
Information system
o Provincial, district, hospital, municipal
SDN (guaranteed and integrated health services)
Sustainable health human resource development and augmentation
o Hospitals, municipal health office
M-6:
Coaching 3
M-6-7:
Implementation and Monitoring
M-8:
ESG 2
M-9-14:
Practicum and coaching
M-10:
M-11:
M-12:
M-13:
M-14:
M-15:
Colloquium
M-16:
Retreat and Program Evaluation
PBLI:
Where and when do technical coach come in?
What are the specific expectations from the technical coaches?
ESG Design
General Objective:
The governor learns bridging leadership and health systems development with fellow governors.
Specific Objectives:
1. Explain the province’s current health situation.
2. Articulate his/her vision for the province.
3. Define his/her personal response to the challenge and to the attainment of the vision.
4. Frame the response in the context of his leadership journey.
5. Plan for the implementation of his/her personal response.
Method: leadership and technical inputs, peer learning, workshop
Output: drawing/model of current and preferred realities, leadership lifeline, and action plan
PBLI:
How with the action plan look like?
Comprehensive health action plans?
Focused health action plans - maternal health. malnutrition, and one social determinants (Is this what coaches will assist in refining?)
The provincial health system – a learning system.
PBLI:
Is this a better term than continual improvement system?
Monitoring and evaluation
Health burden
Indicators chosen by the province to measure progress in the prioritized health burden disaggregated by any or all of the following to measure for inequities - place of residence, ethnicity, occupation, gender, religion, education, socio-economic status, and social capital.
Advisable to have only 3 to 5 indicators unless there is an evidence of an existing robust information system.
Social determinants of health
Indicators chosen by the province disaggregated by any or all of the following to measure for inequities - place of residence, ethnicity, occupation, gender, religion, education, socio-economic status, and social capital. Chosen SDH indicators must include those that most directly affect the prioritized health burden.
Advisable to have only 3 to 5 indicators unless there is an evidence of an existing robust information system.
PBLI:
Do we use the ZFF roadmap? Or the governors create their own criteria and indicators? Target within 16 months?
BL competency
BL competency of governors will be assessed by the coaches during the first and last coaching.
PBLI:
What are the criteria and indicators of BL competency?
How will they ensure "sustainability"?
Job Description of Technical Coaches
PBLI:
Have you formulated the specific job prescription of the technical coaches?
If none, can you give us a general idea how it would look like?
Example,
Do the technical coaches visit their designated provinces every month (16 or 14 or 12 month etc?)
Should the technical coaches be present in the ESGs?
Do the technical coaches also coach the Governors on technical issues or the Regional Directors will be the ones coaching?
Do we coach the PHOs and COHs only? Do we also coach the PHTL and ZFF account personnel?
etc.
Integrated Health Service Delivery Networks
“a network of organizations that provides, or makes arrangements to provide equitable, comprehensive, integrated, and continuous health services to a defined population and is willing to be held accountable for its clinical and economic outcomes and the health status of the population served.”
SOURCE: Modified from Shortell SM; Anderson DA; Gillies, RR; Mitchell JB; Morgan KL. Building Integrated Systems:The Holographic Organization. Healthcare Forum Journal 1993; 36(2):20–6
Definition of comprehensive, integrated, and continuous health services is proposed:
“the management and delivery of health services such that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative care services, through the different levels and sites of care within the health system, and according to their needs throughout the life course.”
SOURCE: Modified from WHO. Integrated Health Services–What and Why? Technical Brief No.1, May 2008.
Concept of continuity of care refers to how people experience the level of integration of services, and can be defined as:
“the degree to which a series of discrete health care events is experienced by people as coherent and interconnected over time, and consistent with their health needs and preferences.”
SOURCE: Modified from Haggerty JL, Reid RJ, Freeman GK, Starfield B, Adair CE, McKendry R. Continuity of Care: A Multidisciplinary Review. 2003; 327(7425):1219–1221 BMJ.
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