Health Policy and Planning Advance Access originally published online on November 23, 2005
Health Policy and Planning 2006 21(1):65-74; doi:10.1093/heapol/czj006
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Original article |
The health service coverage of quality-certified primary health care units in Metro-Manila, the Philippines
Adviser, Local Health Systems Development, German Technical Cooperation (GTZ), Philippines
Correspondence: Amador R Catacutan, MD, 5 Real Street, Real Village No. 1, Tandang Sora, Quezon City 1116, The Philippines. Tel: +632 927-2482; E-mail: amadorcatacutan{at}yahoo.com
Introduction: In 1998, the Philippines’ Department of Health implemented the Quality Assurance Programme, known as the Sentrong Sigla (Centre of Vitality) Movement, starting with primary health care units. The Department established the National Objectives for Health in 1999, which set targets for health status and service coverage by 2004. The Movement certifies primary health care facilities that comply with its list of quality standards. Three years after implementation of the Sentrong Sigla Movement, the present study assessed it as an intervention for the delivery of health care services. Specifically, it evaluated the 2001 service coverage among certified facilities and compared it with that of non-certified facilities in the National Capital Region (Metro-Manila) of the Philippines, and related service coverage to the targets of the National Objectives for Health for 2001.
Methods: For the intervention group, the study randomly selected 82 of the 143 certified facilities (57.3%), with 88 of the 223 non-certified facilities (39.5%) serving as the control group. Using reliable and valid measurement indicator tools, data were collected on preventive health services programmes, curative programmes and monitoring programmes. To compare service coverage of the intervention and control groups, the data were analyzed using chi-squared tests, prevalence ratios, clustered sampling analysis and linear regressions of the rates.
Results: The overall 2001 service coverage shows that certified facilities had significantly less success in the preventive and monitoring programmes than the non-certified facilities, but were not significantly different in the curative programmes. Neither type of facility reached the targets of the 2001 National Objectives for Health for preventive programmes. After adjusting for clustering, the certified facilities showed significantly lower service coverage, compared with non-certified facilities, only for enrolling new acceptors to the Family Planning Programme and for water-supply testing in the Environmental Sanitation Programme.
Conclusion: Unlike previous studies, the results and analysis of the present study show that, generally, the Sentrong Sigla Movement had not improved the processes required to achieve better outcomes. Factors that could have contributed to the findings are described and strategies for improvement are recommended.
Key Words: quality assurance, primary health care, service coverage, health services, Manila, Philippines
1World Bank, Health Population and Nutrition websites: [http://www1.worldbank.org/hnp/] and [http://www1.worldbank.org/hnp/tools.asp]