Perceived challenges of an

integrated system: an MHO’s

perspective
Juhani Capeding, MD
 Experience in current local efforts in health
systems integration:
The Inter-local Health Zone (ILHZ) Experience
Structure of the ILHZ:
Clustering of municipalities
Core referral hospital

Goals of the ILHZ:

integrated planning
continuity of public health and curative care
quality and holistic care
The ILHZ experience: Initial stalled efforts
Memorandum of Agreement was never finalized

Factors:
• Disagreements on resource sharing
• Disagreements on priority investments
• Disconnect between the two biggest institutions on the ILHZ
The ILHZ experience: Changes
• The ILHZ was divided into two groups:
• The three island municipalities separated from the mainland members
• The areas share the same population characteristics, health needs, and system
challenges
• Share same priorities for investment
• It will also be easier to navigate the political environment.
The ILHZ experience: Improvements
• The situation drastically improved
• Faster policy approvals
• Integrated planning between members
• Some observations:
• The ILHZ board was easy to convene, even beyond the prescribed regular
monthly meetings
• Strong provincial support for the ILHZ
• Financial incentives linked to ILHZ milestones
• Non-financial incentives: ambulance, ILHZ Office
The ILHZ experience: New set of challenges
• ILHZ main objective: improve patient experience
• Decrease referral costs
• Improve hospital experience
The ILHZ experience: New set of challenges
• Challenge: financing
• Slow disbursement of funds through LGU processes
• Unclear guidelines, different understanding of the guidelines between DOH,
BIR-SEC
• Challenge: improvement of patient experience
• Coordination means constant awareness of where the patient is in the
network
• In order to be responsive, dedicated resources may be needed for all things
integration and coordination
Barriers and facilitating factors for local
efforts of integration
Barriers Facilitators
• Poor interpersonal and inter- • Incentives for integration efforts
institutional relations • Strong political will, politically
• Disagreements in resource feasible strategies
sharing and handling
• Different interpretation of
guidelines
Perceived challenges for MHOs:
transition and post-integration
Perceived challenges for MHOs post-
integration: a primary care coordinator
• UHC Act:
• “the primary care provider acting as navigator and coordinator of care within
the network”

• Navigating the service delivery network

• Establishing networks that includes private sector
• Establishment of clear roles and terms of the relationship between service
providers
• Especially for providers of both population-based and individual based services like
RHUs
Perceived challenges for MHOs post-
integration: a primary care coordinator (cont.)
• Coordination mechanisms available to the primary care provider
• Coordination opportunities between levels of care
• Opportunities to review integration of care
• Lines of communication available to members of the network
• Care coordinator
• Sharing of health information
• EMRs are currently non interoperable
• Aside from electronic records, we need to establish priority health data to be shared
between providers
Perceived challenges for MHOs post-
integration: health systems planning
• With the establishment of the Special Health Fund, we need to ensure that
the resources assigned to an area is commensurate to its needs

• Assessment of health needs

• Need to define what services are expected for each component
• Difficulty estimating actual costs for a system
• Lack of standard of care between providers
• Procurement practices differ from area to
area
• Integration manager
• Looks at the continuity of health services, duplications, inefficiencies
Perceived challenges for MHOs post-
integration: transition issues
• Transferring administrative and technical supervision to the province
• Political affiliations may complicate transfer of authority
• What happens to the plantilla positions

• Accountability
• Investment of municipalities for health
• What is expected from the Special Health Fund, what are the expectations from the LGU
Conclusion
• There is a need for technical assistance targeting MHOs in terms of
capacity building for new roles emphasized by the UHC Act.
• It is important to be aware of the barriers and facilitating factors of
the ILHZ and the SDN experience, as we will build upon these existing
models of integration to achieve province-level integration of health
systems.