Name of Office: Bureau of Local Health Development

There are 3 domains of benefits in a functional ILHZ:

Domain I: coordination for maximum improvement of population health

• Every pregnancy in the ILHZ is planned, supported & adequately managed throughout its course
• Every delivery is facility based and managed by skilled birth attendants
• Every child has access to and utilizes the recommended package of child survival interventions
• Infectious disease is controlled and endemic diseases are controlled/eliminated in the ILHZ
• Infectious due to poor sanitation and unsafe water are prevented
• Community members in the ILHZ practice healthy lifestyle

Domain II: coordination for continuity of care to individual patients

• Access to an adequate primary medical care service through outlets linked to an organized quality assurance system, referral and technical support
• Access to secondary care linked with the primary level of care and to at least one source of tertiary care
• Access to essential drugs from outlets that meet the regulatory standards and promote rational drug use
• Mechanism that tracks and monitors all patients across service delivery points (SDPs) in the ILHZ

Domain III: coordination to manage and minimize total costs of full range of health provisions

• ILHZ planning helped member LGUs achieve their goals and targets and improve their performance
• Complete accurate and timely health information helped member LGUs achieve goals and targets and improved performance disseminated and utilized ILHZ-wide
• Epidemic is promptly detected and effectively managed within the ILHZ 
• Hazard, disaster or any emergency is effectively managed and contained in the ILHZ
• Functional management arrangements increase ILHZ-wide performance and reduce variability of performance among member LGUs

Name of Office: Bureau of Local Health Development

Currently, a baseline assessment of ILHZs is being done in the F16 provinces.  A nation-wide assessment of ILHZ functionality will be conducted after finalization of the assessment tool in Q2, 2011. 

Name of Office: Bureau of Local Health Development

Currently there is none, but an incentive scheme shall be developed for functional ILHZs based on achievement of pre-selected indicators from the domains of benefits. 

Name of Office: Bureau of Local Health Development

There are 4 levels of indicators to measure functionality of ILHZs:

Capacity indicators: what the ILHZ has

• For Domains I and II: available, adequate, right category and appropriately trained health personnel; health facility infrastructure and functional equipment; adequate commodities and supplies; available protocols/ CPGs /systems guide and funds for services/activities
• For Domain III: Established systems/ guides for functions; structures and staff to support and run systems;  available funds to operate and sustain coordination mechanisms

Effort Indicators: what the ILHZ does with what it has

• For Domains I, II, and III: service delivery networking among service delivery points and other stakeholders; joint financing schemes; ILHZ-wide promotion and information dissemination ; joint outreach activities and services; ILHZ-wide supervision including M & E; adoption of regulatory measures across ILHZ

Coverage and Utilization Indicators: Who and to what extent the ILHZ is reaching and serving

• For Domain I: program performance indicators
• For Domain II: increasing caseload; increasing individual cases properly managed, treated and referred to appropriate health care facilities; network of service delivery points (SDPs) in ILHZ tracks and monitors clients across SDPs to ensure continuous treatment and follow-up care;increasing satisfaction of individual clients with availability, affordability and accessibility of essential drugs
• For Domain III: widening scope of concerns addressed; expands annual planning to coverage of  3-5 years; expanding duration and increasing sectoral participation (including private sector) in the various processes in the ILHZ. 

Outcome indicators: What health outcomes the ILHZ is delivering

• For Domain I and II:  reduced mortalities and morbidities in the ILHZ
• For Domain III: absence or minimal occurrence of epidemics/outbreaks in ILHZ; disasters/emergencies minimized/ contained with less number of death/disabilities; stakeholders using and benefitting from the information generated through coordinative systems widens ; increasing performance in the ILHZ as a whole, in individual member LGUs and in all SDPs within the ILHZ which will result in  reduced or no  disparity in performance of member LGUs.

Name of Office: Bureau of Local Health Development

The initial definition of a functional ILHZ looked at inputs/process, namely: signed MOA; presence of Policy Board; Technical Management Committee; ILHZ Plan; documentation of meetings; enrollment of indigents/resource sharing.

The current/new definition of a functional ILHZ looks at results/outcomes/ benefits of inter-LGU coordination in health operations within the ILHZ:

• Improved population-wide health
• Improved care of individuals
• Improved management of health resources

Name of Office: Bureau of Local Health Development

An ILHZ is a clustering of contiguous local government units (municipalities, component cities of a province/s) with a core referral hospital (district or provincial hospital) wherein preventive primary public health care is integrated with hospital care.  It is a district health system in a devolved set-up in which the component local government units (LGUs) cooperate in health operations to better protect the collective health of the catchment community, assure access of individuals in the catchment community to a range of services necessary to meet their health care needs, and to manage more efficiently and equitably the cooperating LGUs’ resources for health.

Name of Office: Bureau of Local Health Development

ARTICLE X SECTION 13 OF THE CONSTITUTION

            “Local Government Units may group themselves, consolidate or coordinate their efforts and resources for the purpose commonly beneficial to them in accordance to the law.”

LOCAL GOVERNMENT CODE 1991 SECTION 33

            “This allows for Inter-LGU cooperation to occur through Memoranda of Agreement for mutually beneficial purposes, with agreed contributions of staff, financial and capital resources in whatever manner that suits the LGU concerned.” 

Name of Office: Bureau of Local Health Development

Governor’s Executive Order to initiate the process and a Sanggunian Bayan /Sanggunian Panlalawigan Resolution authorizing the LGU to enter into a Memorandum of Agreement (MOA) with the cooperating LGUs in the ILHZ. 

Name of Office: Bureau of Local Health Development

As of February, 2010 there are 312 ILHZs in the Philippines. Pls. see attached table for details.

Name of Office: Bureau of Local Health Development

The ILHZ is composed of a policy board which is its policy-making and coordinating body and a technical management committee which executes the plans and activities of the ILHZ.

The Policy Board is made up of local officials of the component LGUs, representatives of non-government organizations (NGOs), national agencies (NGAs), the private sector, and community.

The Technical Management Committee may be composed of the Chief of the Core Referral Hospital, MHOs, Representative Public Health Nurse (PHN), Chief Nurse of Core Referral Hospital, Representative Rural Health Midwife (RHM), Supervising Rural Sanitary Inspector (RSI), DOH Representative, Private Health Care Provider.    

Name of Office: Bureau of Local Health Development

The ILHZ is the basic functional structure for health service management and gate-keeping (instead of the RHUs/health centers) and as such the ILHZ contributes to the attainment of Province-wide Investment Plan for Health /Annual Operational Plan (PIPH/AOP) objectives, reduces disparity in performance of member LGUs and contributes to the improved performance of the PWHS.