Talk to Global Health Masteral Students of Northwestern University

1. Procurement System
in the Philippines
Teodoro J. Herbosa MD FPCS
College of Medicine & National Telehealth Center
University of the Philippines, Manila
Former Undersecretary of Health
Republic of the Philippines

2. Outline
• Background information: Philippines
• Philippine Health System
• Government Procurement System
• Procurement of Medicines
• Health Financing
• Public Private Partnership
• Case discussion

3. Republic of the Philippines
Southeast Asia
Archipelago 7,107 islands
100million people
Democracy
Low Middle Income
Colonized by Spain, USA
and Japan

4. Statistical Figures
Population (May 2010) 92.34M
Population (Aug 2007) 88.55M
Inflation Rate (Jun 2015) 1.2 %
Total Exports(Apr 2015) $4.38Bp
Total Imports (May 2015) $4.39Bp
Balance of Trade (May 2015)
$508.86M
Employment Rate (Apr 2015)
93.6%p
Unemployment Rate (Apr 2015)
6.4%p
Underemployment Rate (Apr 2015)
17.8%p
LFPR (Apr 2015) 64.6%p
Simple Literacy (2000) 92.3%
Functional Literacy (2008) 86.4%
Average Family Income(2012)

5. Health System
• "Two" health systems
• Private healthcare vs Public healthcare = health
inequity
• Centralized to Decentralized
• Infrastructure gap hospital bed to pop is 5/10,000
• Rapid population growth
• Increasing health costs

7. • Health Indices and Statistics
• Total population (2013) 98,394,000
• Gross national income per capita (PPP international $, 2013) 7
• Life expectancy at birth m/f (years, 2013) 65/72
• Probability of dying under five (per 1 000 live births, 0) not
available
• Probability of dying between 15 and 60 years m/f (per 1 000
population, 2013) 255/136
• Total expenditure on health per capita (Intl $, 2013) 287
• Total expenditure on health as % of GDP (2013) 4.4
• Latest data available from the Global Health Observatory

8. Health Reforms
• Primary Health Care "Alma Ata"
• Corporate government hospitals
• Generics Law
• Decentralization (devolution) Local Government Code
• National Health Insurance Act
• Health Reform Agenda
• Universal Health Care (Sin Tax Financing)

9. Government Procurement
• RA 9184
• Post qualification methodology
• Head of Procuring Entity (HOPE)
• Bids and Awards Committee (BAC)
• Technical Working Group (TWG)
• Recommendation to Award (RTA)
• Notice of Award (NOA)
• Purchase Order (PO) or Contract

10. Corruption
• Collusion
• Price manipulation; overpricing
• Kickbacks
• Insider information
• Fake qualification documents
• Variability of costs

11. Procurement of Medicines
• Programs ("vertical") TB, vaccines, leprosy,
• Vaccines (EPI) Expanded Program of
Immunization
• TB (NTP) National Tuberculosis Program
• Leprosy (NLP) National Leprosy Program
• Others

13. • What is Medicines Access Programs (MAPs)
• Types of MAPs
• MAPs for out-patient care:
• Botika ng Barangay (BnB)
• DOH Complete Treatment Pack (DOH ComPack)
• MAPs for in-patient care:
• Regular in-patient care
• Catastrophic Care
• Acute Lymphocytic Leukemia Medicines Access Program
• Breast Cancer Medicines Access Program
• Rare Disease Medicines Access Program
• Other MAPs
• DOH Insulin Access Program
• Valsartan Access Program
• Geriatric Health Care Medicines Access Program
• Mental Health Care Medicines Access Program

14. • Universal Health Care (UHC) and Access to Medicines
• Universal Health Care (UHC) is the call and commitment
of the Philippine Government to ensure that every
Filipino has access to quality and affordable health care.
• In 2011, the Department of Health announced its goal to
achieve UHC under the flagship program of President
Benigno Aquino III known as Kalusugan Pangkalahatan
(KP) focusing on improving access to health care
services and reducing poverty from catastrophic
healthcare expenditures especially for the poor and
most vulnerable population.

15. • Universal Health Care (UHC) and Access to Medicines
• .To achieve Universal Health Care (UHC), or Kalusugan Pangkalahatan
(KP), is defined as the "provision to every Filipino of the highest possible
quality of health care that is accessible, efficient, equitability distributed,
adequately funded, fairly financed, and a appropriately used by an
informed and empowered public". The administration puts it on top of the
socioeconomic agenda to improve the health and quality of life.
• To attain UHC, the DOH defined three strategic thrusts to be pursued
from 2011-2016, namely:
• 1) Achieve the health-related Millennium Development Goals (MDGs) of
improving maternal and child health and combating priority infectious and
non-communicable diseases;
• 2) Provide financial risk protection through expansion in the enrollment
and benefit delivery of the National Health Insurance Program (NHIP); and
• 3) Improve access to quality health care which includes the upgrading of
public hospital and health facilities, ensuring adequate health human
resources and securing the availability of essential medicines.

16. NCD Control: Primary Care
• Non-communicable disease burden
• Hypertension control
• Diabetes control
• Asthma management
• Acute infections

17. Public Private Partnership
• improve access to health facilities and services
• Infrastructure gap in the health system
• 5 hospital beds/10,000 pop.
• Long length of stay because of efficiency
• Lack of funds
• Brain drain

18. PPP
▪ The project aims to raise health standards through the
upgrading and modernization of the facilities. The project
components cover the following:
• Construction of new healthcare building and facilities.
• Hospital facilities involves the entire development and
identifying the services required, and overall delivery of
services.
• Hospital Equipment, furniture & fixtures: Provision of
medical equipment including hospital beds, etc.
• Total Computerization. Hospital Information system
linked between medical and administrative as well as
external stakeholders (Philippine Health Insurance
Corporation (Philhealth), Department of Health (DOH),
Department of Budget and Management (DBM), etc.).
• Training and Technology Transfer

19. www.doh.gov.ph
NKTI Hemodialysis Center
• Procured in 2003 under lease agreement for 5 years and was renewed again in 2009
• At present, there are 47 dialysis machines in operation at the new hemodialysis center
of NKTI
• Status: Second contract is being implemented; third contract will be for bidding

20. www.doh.gov.ph
NKTI PET-CT and Cyclotron Project
• Include building construction in a 230 square meter vacant lot beside the Diagnostic
Center of NKTI for housing of the Cyclotron for the production of fluorodeoxyglucose
(FDG)
• Supply of equipment and related facilities in the operation of the Positron Emission
Tomography (PET) and Computerized Tomography (CT);

21. www.doh.gov.ph
Modernization of Philippine Orthopedic Center
• PhP5.6 Billion £83.5Million
• 700-bed capacity specialty hospital
• Build-Operate Transfer Contract for 25 years.
• Status: Ongoing procurement of Independent Consultant

22. www.doh.gov.ph
Modernization of Bicol Medical Center
• PhP855 Million (£12.7Million)– funded by the government through DOH
• 800-bed capacity hospital
• Design and Build Scheme – ongoing construction

23. www.doh.gov.ph
Modernization of Cagayan Valley Medical Center
• PhP305 Million (£4.55 Million) – funded by the government through DOH
• 600-bed capacity hospital
• Design and Build Scheme – ongoing construction

24. www.doh.gov.ph
Regional Cancer Centers
• PhP75 Million (£1.12 Million) – infrastructure funded by the government through DOH
• Of the nine cancer centers, three (BGHMC, NKTI, RMC) has already its Oncology
Equipment provided by the Private Sector investor through sharing arrangement under
Service Management Contract
• CVMC
• BGHMC
• ZCMC
• NMMC
• VSMMC
• WVMC
• BMC
• NKTI, RMC
• SPMC

25. Summary
• Background information: Philippines
• Philippine Health System
• Government Procurement System
• Procurement of Medicines
• Health Financing
• Public Private Partnership
• Case discussion