HEALTH COUPON PROGRAM
Provincial Government of Quezon

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Limited access to healthcare is one of the biggest challenges that confronts the Province of Quezon. With 1, 242 barangays comprising the 39 municipalities (27 of which are geographically isolated and disadvantaged areas) and 2 cities, with a total population of 2,122,830 spread across the 8,962 sq. km land area, the Provincial Government is determined to respond to the following health care and health related issues: a.Inadequate medical assistance program b.Inadequate hospital services and facilities c.Insufficient drugs and medical supplies d.High prevalence in malnutrition (12.9%, 2010) e.High poverty incidence (22.8% of total families in the province, 2012) f.Poor health seeking behavior The poor health seeking behavior of the average Quezonian is attributed to the rural practice of consulting to quack doctors in order to relieve sickness while prevalence rate in malnutrition are attributed to poverty and lack of accessible health facilities. Before the initiative, the only medical aid that Quezon Provincial Government maximizes to extend to the public is the financial assistance distributed through the AICS, (Assistance to Individuals in Crisis Situation), a program administered by the Provincial Social Welfare and Development Office. However, this program proves to be an insufficient health aide to indigent beneficiaries not to mention undergoes a rather tedious process to avail. In addition to this is the fact that extended financial assistance granted through AICS cannot be monitored and guaranteed to be used solely for medical purposes. Bearing all these in mind, the Provincial Government is challenged to address the provision of accessible and adequate health care and health aide, being a prime right of every individual

B. Strategic Approach

 2. What was the solution?
The solution to the problem is an accessible and innovative health care program that will cater to the immediate health / medical services needed by patients in any hospitals owned and managed by the province, with serviceable and improved hospital facilities, such as but not limited to: Medical check-up Laboratory Services Radiology Services Dialysis Rehabilitation Out-patient Department Services Drugs and Medicines The initiative is all about providing quality health care service that is accessible, efficient, evenly distributed, adequately funded, fairly financed and appropriately used by the empowered Quezonians.

 3. How did the initiative solve the problem and improve people’s lives?
The initiative decentralized the health assistance provided by the Provincial Government by distributing health coupons with face value to barangay chief executives for easy-access of the marginalized sector in availing medical services. Upon assessment and interview of the patient in the barangay office, the barangay captain, will issue both certification of indigence and issue health coupons to patient for availing free medical services to the nearest province-owned hospital. Through this initiative, both the delay and inadequacy in providing health aid to the public is immediately addressed in the barangay level. Since the total amount of coupons received by hospital’s billing department from patient/ beneficiary is treated as payments for hospital services availed and considered as receivables from the Provincial Government, the latter accounts for coupons received through the Provincial Accounting Office, which, instead of giving the cash equivalent to hospitals, resupplies the hospitals’ needs, equipment, medicines and improve hospital plants and facilities. As such, the implementation of this initiative resulted to efficient delivery of health assistance in the barangay level, continuous development of hospital facilities and improvement in the health-seeking behaviour of the wide marginalized sector in taking care of their health conditions.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
A.Effective and efficient medical aid to all The empowered and direct involvement of the barangay officials in the validation, certification and distribution of health coupons to program beneficiaries fosters immediate assistance to their constituents and strengthens the community relationship between the local government officials and the citizens through frequent interaction. B.Improved accessibility in public health services The initiative eliminates the usual bureaucratic system of patients/ beneficiaries queuing in the municipal and provincial capitol for financial assistance to await health aid with no certainty. C.Eradication of corruption and misuse of funds The initiative removes the distribution of cash to the beneficiaries, ensuring that they cannot use health coupons for purposes other than addressing medical and health needs. D.Catalyst in improving health facilities This initiative compelled the provincial government to reach out to different national agencies that assisted in the improvements in the services and facilities of all 16 province-owned and managed hospitals that guaranteed the maximized utilization of the coupons for medical services. E.Establishment of partnership with private institutions To ensure sufficient supply and quick replenishment of medicines in the hospitals, the health initiative ventured in partnership with different private local pharmaceutical companies by entering into a drug consignment agreement with the provincial government. F.Strengthened the referral system among Inter-Local Health Zones The linkages and referral system among Local Government Units’ municipal health offices to the provincial owned hospitals, especially in coordinating operations from core referral hospital to end-referral hospitals, are strengthened due to the presence of this initiative.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The initiative is implemented by the Provincial Government of Quezon, Sangguniang Panlalawigan, Barangay Local Government Units and the provincial government hospitals, committed to deliver efficient health care service to 1,242 barangays of the province, prioritizing the marginalized sector. As of 2016, the initiative has already accommodated and serviced a total of 301,418 individuals from the time it was implemented in 2010 until the second quarter of 2016. The number of the beneficiaries of this initiative is clearly overwhelming compared to the traditional AICS program that only benefitted a total of 37, 051 individuals from 2010 until the end of 2016. This is a clear indication that the Provincial Government has been maximizing its health aid in a wider scope and extensive scale in the previous years of its implementation.
 6. How was the strategy implemented and what resources were mobilized?
A series of informal consultations/ meetings with Local Chief Executives of the municipalities, barangay officials, and local health boards was conducted by the Provincial Government of Quezon relative to the health issues that confront the province. The general conclusion drawn is that the poor health-seeking behaviour of an average Quezonian is factored by poverty (meagre income), limited health care services and facilities present in community or district hospitals, inadequate health aid from the government institutions and the distance of rural barangays from the town proper where community hospitals and municipal governments are situated. The Quezon Provincial Government launched the initiative through issuance of E.O. 35 series of 2010, “LINGAP KALUSUGAN PARA SA QUEZONIAN”, highlighting the health program’s institutionalization, creation of project Management Team and its appropriation. Hence, an amount of PHP 62M was initially appropriated by the Provincial Government from the General Fund for the implementation. The provincial government then printed and prepared the health coupons for distribution to 1,242 barangays of the province. Barangay captains, usually of clustered municipalities, are then invited to attend the turn over ceremony of health coupons with short orientation and guidelines as to the usage of coupons. Each of the barangay receives an equivalent of Php 50, 000.00 worth of health coupons, per annum, with Php 100 and Php 200 face value denomination and corresponding serial coupon numbers. At the end of the program, the coupons and data sheets are released to the barangay captains by signing the acceptance documents prepared by the provincial government. The barangay local government is the unit responsible for the assessment and issuance of certification of the indigence of patients. They are also in-charge of distributing health coupons to program beneficiaries as an immediate medical assistance to be used for any hospital services. Upon availing hospital services, patient’s medical bill along with their coupons are presented to the designated help desks for quick verification and processing. Coupons deducted in the total amount of the billing department shall be treated as income receivables from Quezon Provincial Governments which will then appropriate its equivalence for improvement of public health services. As such, for this initiative, disbursement of funds from the appropriation in the General Fund will be made only when transferring of funds to the Account of the Hospitals and therefore is subject to existing accounting, budgeting and auditing rules and regulations of the Provincial Government. The vouchers shall be the basis of transfer of funds from the appropriation in the General Fund to the accounts of provincial hospitals (General Fund Proper and Trust Fund for consignment) where coupons have been presented. Health coupons shall be valid for one year and limitations on allowable amounts of coupons also apply to both in-patients and out-patients. For patients that use medical coverage of government health insurance, the first must be applied before the deductions from health coupons to the remaining balance of the medical bill. Unused funds (coupons) for this program which has been closed at the end of the year is verified by the Provincial Accounting Office and is re-appropriated next year for the same purpose.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The stakeholders of this initiative is the Provincial Government of Quezon as the prime implementer of the initiative; the Sangguniang Panlalawigan that institutionalized the initiative through passage of an ordinance; the provincial government owned and managed hospitals; the private pharmaceutical companies that partnered with the Provincial Government through consignment agreement for the replenishing of drugs and medicines; and the national government agencies that assisted in the improvements of hospital facilities, such as the Department of Health and the DPWH. The Quezon Provincial Government also tapped-in informal leaders in the barangays such as parent leaders and barangay coordinators, barangay health workers and barangay nutrition scholars to ensure community awareness on the initiative.

 8. What were the most successful outputs and why was the initiative effective?
The initiative provided for the following concrete outputs: a.The initiative effectively addressed the issue on both the delay and inadequacy of health aid provided by the Provincial Government. Based on the number of total beneficiaries, the initiative has reached 301,418 Quezonians who are in need of medical aid. b.The accessibility of health coupons eliminated the constituent’s propensity to wait for the disease to manifest in the late stage before seeking health care services. Rather, they became comfortable to ask for coupons in the barangay in order to avail free medical check-ups and laboratories. Thus, the overall health-seeking behavior of the public has generally improved. c.The initiative also strengthened the working relationship between the Provincial Government and the barangay officials in providing health program and services in the barangay level, resulting to the promotion of the integrity of local units of the government. d.Another positive output of the program is highlighted through the initiative’s eradication of misuse of public funds doled out as financial assistance. e.Ultimately, due to the initiative’s goal of providing adequate health facilities, hospital receivables from the Provincial Government were appropriated for the improvements of medical facilities, to wit: Construction of Quezon Medical Center Annex Construction of New Gumaca District Hospital Building Construction of New Claro M. Recto Memorial District Hospital State of the art CT Scan at Quezon Medical Center Mammography and Cryotherapy Machines for women’s health center New X-ray machines for district hospitals Dialysis machines Quezon Medical Center

 9. What were the main obstacles encountered and how were they overcome?
During the first year of the initiative’s implementation, the use of health coupon was limited only to the health facilities and medicines available in hospitals managed by the Provincial Government. Overall, the lack of medicines and other health facilities minimized the aid extended by Quezon Government. Therefore, massive hospital infrastructure developments were implemented from the following year, alongside investments for medical equipment, in order to boost the access to health services. A consignment agreement was also established between the provincial government and pharmaceutical companies in order to sufficiently supply a wide range of medicines and hospital supplies needed.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Through this initiative, the Provincial Government eluded the traditional system of doling out cash as a form of medical assistance to indigent patients. An effective delivery of health service is rendered immediately in the barangay level which not only eliminates the very stringent process of seeking medical aid from the provincial capitol but also greatly motivates and improves the health-seeking behaviour of the people in the barangay. Since barangay captains became implementing agents of this initiative, specifically in the assessment and distribution of health coupons to the most vulnerable, the barangay officials became healthcare service partners of the provincial government. Also, the health program is not confined or restricted to specific gender or age of patients. The basis of extending the assistance to patients is their socio-economic condition or status and their indigence. The impact of the initiative as a healthcare program is measured through the reports submitted to the Office of the Provincial Accountant and Internal Audit that reflects the total amount of health assistance provided for the patients. Also, the implementation of the initiative impacted in the goal of lowering malnutrition and poverty rate in the province. From 17.94% in 2010, the malnutrition rate declined to 9.32% in 2016 while the poverty rate from 22.8% declined to 22.3% in the past year. Overall, better appreciation of the health program is reflected in the testimonials of the recipients due to the easy-access and hassle-free health care initiative.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
he initiative undoubtedly improved integrity in public service for paving way to accessible and corrupt-free medical aid program to the general public. The health coupons received by patients are non-convertible to cash and can only be used for health services in hospitals owned and managed by the Provincial Government. There is also no room for corruption in the financial management of the hospitals. Since all coupons are regarded as receivables from Quezon Provincial Government, the latter takes direct responsibility of supplying the needs and improving health facilities as form of payment. Accountability of this initiative is reflected in the health coupons which bear the logo of the Provincial Government as well as other details that can be referred to when problem in usage of coupons arises. Thus, any issues on the inefficiency of health coupons can be reported to the barangay and or the provincial level for improvements.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The initiative follows a general prioritization to the marginalized sector of the general public, including the most vulnerable members of the society such as the women, children, the elderly, the differently abled and the pregnant women in the barangay. All beneficiaries who are more susceptible to diseases and are in need of wider assistance for their health are given more priority, as indicated in the guidelines for distributing health coupons. The initiative also pushed for the enhancement of hospital equipment for women’s health center such as mammogram and ultrasound machines.

Contact Information

Institution Name:   Provincial Government of Quezon
Institution Type:   Government Department  
Contact Person:   DAVID SUAREZ
Title:   Program Chief Implementer  
Telephone/ Fax:   042-373-6008
Institution's / Project's Website:  
E-mail:   pgo_executive@yahoo.com  
Address:   Brgy. F De Hesus, UNISAN
Postal Code:   4305
City:  
State/Province:   Quezon
Country:  

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