EVALUACIÓN DE PROPUESTAS

EPI and TBCP, defeated the objectives of the program to detect new sputum smear-positive TB cases and cure new sputum smear-positive TB cases discovered, respectively. Also, the hiring of only 734 nurses with corresponding disbursement of P12,236,012.79 out of the 950 targeted health professionals for the RNheals Program with allocated funds totaling P21,960,000.00, resulted to the non-achievement of the program designed for the unemployed registered health professionals, particularly the nurses and midwives for their learning and deployment.

In CY 2011, the DOH-CO sub-allotted to the CHD for Calabarzon the amount of P36,100,000.00 for the MR-SIA, in addition to the continuing appropriation (CONAP) for CY 2010 of P750,000.00. The amount of P912,300.00 from the current year’s appropriation of the CHD was allotted for the Routine EPI, which was not utilized.

The target for MR-SIA is to immunize 95% of infants’ ages nine to 95 months. Only Rizal Province, the Cities of Calamba, Lipa, Sta. Rosa, and Trece Martires exceeded the targets of immunization on infants. Eight provinces/cities were below 85 percent, while six were below 95 percent. The shortfall of eight percent (95%-87%) was partly due to the “missed children” totaling 43,471 who were either sick, on vacation, with private doctors, or other reasons.

On the Routine EPI, the utilization of the EPI Vaccines was low vis-à-vis the targets of 2.7 percent and 3.5 percent of the total population of infant below one year and pregnant women. Only 69.84 percent of the total eligible population of infants below one year old were fully immunized and 37.15 percent of the total eligible population of pregnant women was immunized with Tetanus Toxoid 2.

Vaccines

Infant below 1 Year Pregnant Women

Eligible

Population VaccinatedPopulation % PopulationEligible VaccinatedPopulation %

2.7% of the total population 331,857

3.5% of the total population 430,184

Tuberculosis Vaccine (BCG) 268,803 81.00

Measles Vaccine 224,187 67.56

Diphtheria Tetanus Pertussis 3 229,796 69.25

Oral Polio Vaccine 3 262,335 79.05

Hepatitis B 3 222,005 66.90

Fully Immunized Child 231,783 69.84

Tetanus Toxoid 2 159,807 37.15

The Program Manager explained that the low percentage on immunization was due to several factors, such as (a) insufficient and shortage of 267,250 vials of EPI Vaccines; (b) lack of manpower for the Monitoring and Supervision Activities; and (c) enormous roles of the LGUs (PHOs, CHOs, RHUs, and DOH Representatives) in the realization of the EPI.

The following problems were cited at the LGU level which contributed to the low performance of the CHD on the EPI:

a) failure to monitor the drop-outs (people who begin the vaccination schedule but did not complete it);

b) lack of manpower at the LGUs level as well as lack of transportation allowance; and

c) failure to conduct outreach activities and other programs were prioritized. Clearly, the CDR of the CHD had a continuous increase from CYs 2006 to 2010, but these still fell below the national target of 70 percent by an average of 17.21 percent. CR also fell below the national target of 85 percent by an average of 8.5 percent.

The following factors, among others, have also contributed to the low performance of the Region:

a) sub-allotments from the DOH-CO amounting to P23,638,755.00 and P500,000.00 from the TBCP funds were realigned to Kalusugang Pangkalahatan Program (KPP). Also, out of P16,011,053.00 allotments/sub-allotments for CHD for the TBCP only P4,840,186.62 was obligated/utilized, leaving a balance of P11,170,866.38;

b) CHD did not prepare a WFP for the Continuing Appropriation for CY 2010 amounting to P949,653.00;

c) of the total allotment of P3,877,662.82 for monitoring and evaluation, the CHD utilized only P873,200.00. Actual monitoring or visitation to the RHUs and PHOs, the CHD utilized only P4,662.82 for traveling expenses and communication expenses of P6,310.00 or a total of P11,093.82;

d) delay in the submission of reports from the RHUs and PHOs and erroneous reports;

e) receipt and issuance of drugs and medicines from the DOH-CO by the CHD-IVA to the RHUs and PHOs could not be determined if these were recorded in their respective books of accounts, hence, accountability and existence of the drugs and medicines could not be established;

f) no applicants for medical technologists, doctors, and nurses in view of the low salary grades offered and lack of LGUs manpower to strictly enforce the monitoring of the RHUs and PHOs;

g) lack of funds for transportation and facilities in some communities posed problem in the implementation of the program; and

h) TBCP is not the priority of the Mayor. There were other projects that were prioritized and deliverables other than the TBCP.

Further, out of the P21,960,000.00 budget of the RNheals Program covering the period from October to December 2011 only P12,236,012.79 or 55.72 percent for the hiring of 734 out of the 950 registered nurses was utilized for the first tranche. Details are shown below;

Hospital

No. of Nurses Funds

Authorized Actual Allotments _{(Amount in PhP)}Obligations Balance

QMMC 273 201 6,552,000.00 5,700,542.32 851,457.68

ARMMC 212 212 5,088,000.00 3,008,965.28 2,079,034.72

NCMH 324 264 6,936,000.00 2,530,900.49 4,405,099.51

LPGHSTC 141 57 3,384,000.00 995,604.70 2,388,395.30

Total 950 734 21,960,000.00 12,236,012.79 9,723,987.21 We recommended that Management direct the:

a) Director of the CHD in Calabarzon to:

• provide internal control measures to get assurance that the EPI Vaccines and TB drugs and medicines are utilized for the intended purpose through (a) inspection backed-up with inspection reports; (b) ensure the recording of the receipt and utilization of the drugs and medicines in the books of accounts of the concerned RHUs, PHOs, and CHOs; and (c) submission of the physical inventory from the concerned RHUs, PHOs, and CHOs to establish existence of the unutilized EPI vaccines;

• ensure that all logistics for immunization are available all the time and are functioning properly;

• intensify the monitoring function of the Program Manager on the following areas: (a) Outcomes - EPI coverage tracks over time to determine if the expected outputs are achieved; (b) Human resources - include the number of staff, their average workload and training; and (c) regular physical check on the stock levels to ensure the availability of vaccines;

• intensify supportive supervision to build the capacity to carry out safe, good quality immunization services in the barangay by providing on-site training and assistance;

• foster political commitment at the LGU level and recommend remedial measures to each LGU on the problems encountered such as: (a) conduct of outreach activities; (b) increase capacity of health facilities to provide immunization service through staff

allocation and skills development, to ensure that all facilities should have adequate staff skilled in provision of immunization services; and (c) monitor drop-outs;

• prepare the WFP refocusing on the monitoring function of the NTP Coordinators;

• establish strong linkage with the LGUs to effectively perform the monitoring function;

• address the problem on lack of manpower;

• maximize the utilization of the TBCP funds for the intended purpose;

• foster political commitment at the LGU level and recommend remedial measures to each LGU on the problems encountered; and

• require compliance on the early submission of the NTP report; and

b) the RNheals Program Managers for QMMC, ARMMC, NCMH and LPGHSTC to complete and fast track the hiring of the authorized number of nurses under the Program.

Delayed Completion of Infrastructure Project and Conversion of Hospital to Tertiary Level

19. The delayed completion of the DOH-TRC Dietary Building with a total cost of