Sentrong Sigla

“All the evidence that we have, indicates that it is reasonable to assume in practically every human being, and with certainly in almost every newborn baby, that there is an active will toward health, an impulse toward growth, or towards the actualization. ” -Abraham Maslow Introduction Department of Health or the Kagawaran ng Kalusugan is the principal health agency here in the Philippines. The department is responsible for ensuring access to basic public health services to all Filipinos through the provision of quality health care and the regulation of providers of health goods and services.

DOH has three major roles in the health sector: (1) leadership in health, (2) enabler and capacity builder, and (3) administrator or specific services. The DOH’s vision is to be the leader of health for all in the Philippines, and its mission is to guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health. While pursuing its vision, DOH adheres to the highest value of work such as: integrity, excellence, compassion and respect for human dignity, commitment, professionalism, teamwork and stewardship of the health of the people.

Because of the department’s dedication in guaranteeing equitable, accessible, sustainable and quality health services for all Filipinos, especially the vulnerable group, the department has formulated different programs to ensure quality health services and one of them is the Sentrong Sigla Program. Sentrong Sigla The Department of Health’s (DOH) Quality in Health (QIH) Program seeks to institutionalize Continuous Quality Improvement or CQI in health care in order to create health impact in terms of health promotion and disease prevention control.

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Sentrong Sigla Certification has been identified as one of the components and strategies of this program. The quality standards cover total systems quality for outpatient care and public services graduated into three levels. This quality standards list (QSL) covers the basic certification level or Level 1. The next higher levels of specialty award and award for excellence, Levels 2 and 3 respectively have their own standards lists. Aside from the QSL, other tools available for use of the health facility staff are the Supervisory Forms (SF) and the Facility Certification Form (FCF).

The Birth of Sentrong Sigla Quality Assurance Program (QAP) Goal: To make DOH and LGUs active partners in providing quality health services. Key Strategies: 1. Certification / Recognition Program (CRP) 2. Continuous Quality Improvement (CQI) In 1999, QAP was renamed the Sentrong Sigla (“Center of Vitality”) Movement (SSM). Sentrong Sigla Movement Goal: Quality health – quality health care, services and facilities. Objectives: Better and more effective collaboration between DOH and LGUs.

Where DOH: serves as a provider of technical and financial assistance package for health care. LGU: serves as prime developers of health systems and direct implementers of health programs.

Specific Objectives:

• Institutionalization of quality assurance
• SS certification targeting 50 % of health facilities in 2003 and 60% in 2004. Pillars:
• Quality assurance
• Grants and technical assistance
• Awards
• Health promotions

To ensure that Sentrong Sigla remains focused on its quality goals and objectives, the following guiding principles are hereby adopted:  Recognition for achieving good quality shall be the main incentive in SS certification. Advocacy and social mobilization activities should be used to enhance the value of prestige and recognition. Other incentives shall not be overemphasized and should only be secondary to recognition. Quality improvement is an unending process.

SS certification should promote the continuing drive for ever – improving quality by providing multi – tiered and progressively higher quality standards. SS certification shall focus on core public health programs that have been proven to be most cost – beneficial to the people such as child health, maternal care and family planning, prevention and control of infectious diseases and promotion of healthy lifestyle. Public health programs are best integrated, synergized and synchronized to achieve maximum health impact. Quality improvement is a partnership that empowers all stakeholders. In SS, communication between the DOH and the health facilities to be certified shall be open and shall be based on mutual trust and transparency. All quality standards and the methods by which these shall be assessed shall be openly shared and discussed to ensure clear understanding and strong commitment by all concerned. In the same spirit, roles, responsibilities and contributions shall promote appropriate counterpart and reciprocity. To ensure even distribution of quality health services, DOH assistance shall be purposive, targeting to achieve quality improvement in health facilities that have been identified using carefully selected health priorities and health needs. These should include health facilities in far – flung and underserved areas, in congested urban centers or in marginalized communities. To ensure objectivity and broad, varying perspectives, SS assessment shall involve partners in health from non – DOH units such as other government and non – government units agencies.

They shall be encouraged to actively advocate for and give support to SS. Sentrong Sigla Certification Phase I Phase I of the certification component started in mid – 1999 and extended until 2002. Sentrong Sigla seals were given to health facilities that met at least 80% of the standards. By mid – 2002, 44% of health centers, 13 % of district and provincial hospitals, and 1 % of BHS have been certified Sentrong Sigla. Additional national awards were given to several health facilities, the prize for which included P 1 Million for health centers, P 3 Million for district hospitals and P 5 Million for provincial hospitals.

More than 135 Million pesos have been awarded to these facilities. The Sentrong Sigla certification during the first phase was successful in terms of promoting interests and participation of local government units in raising the quality of health care in public health facilities and in generating additional support from local chief executives for health and channelling local resources to fund basic equipment, amenities and supplies of local health facilities.

The strategy also confirmed that a mechanism that recognizes good quality health services is a powerful tool to maintain DOH leadership in health, with high potential for eventually creating health impact through more effective and better quality public health programs. Valuable Lessons during Phase I  The realization of the need for total systems quality standards that combine simple yet basic input process and output standards. While the health facilities met input – only standards in Phase I, SSM itself had to be positioned as a total quality movement.

Thus, consumers will equate SS with total quality. “Input only” certified health facilities would raise doubts on the SS seal as a certification of genuine total quality. Changing the standards over the years, as originally planned, was difficult to implement. Besides, The LGUs preferred a stable core of total system quality standards.  The importance of careful selection of incentives. While it is important that incentives be attractive, these should also be appropriate, sensible and sustainable.

During SS Phase I, monetary rewards were too much focused. This generated unprecedented interest but distracted the LGUs away from the real quality objectives of SS. The quest for the million peso prize led them to skip the capability – building step which was really the most important step in the process.  The need for changing procedures to provide adequate time for crucial processes like the internalization of the quality standards by the Local Chief Executive and is local health staff, the provision of supportive technical assistance by the DOH and other quality improvement activities prior to formal assessment. There was also need to provide multiple, progressing quality standards to drive continuing quality improvement. Formulation of the Philippine Quality in Health Program and the Transition into SS Phase II In 2001, with the change of DOH administration, the effort to raise quality of health services was intensified, leading to the expansion of concern for quality beyond the DOH – LGU interaction level into the entire health sector.

Other instruments and interventions that can drive quality higher, such as mandatory licensing and the accreditations and payment scheme of the Philippine Health Insurance Corporation (PHIC) were included. Other efforts of professional societies were also acknowledged and incorporated, resulting in the more integrated Philippine Quality in Health Program AO No. 17 – B s. 2003, replacing the Sentrong Sigla Movement. The certification strategy of the “movement” – The Sentrong Sigla Certification – remained an important strategy in the accreditation approach of the broader Philippine QIH Program.

To harness the full potential of the SS Certification in achieving its quality goals and objectives, basic modifications were adopted for SS Phase II (2003 – 2007) in terms of revised quality standards, procedures and incentives scheme. Goals: As one of the accreditation strategies in the QIH Program, Sentrong Sigla Certification has the same long term and intermediate goals as the Philippine QIH Program: Long – Term Goals:

To institutionalize within the health sector the leadership processes, knowledge, attitudes, skills, and organizations that will generate Continuous Quality Improvement in health care thus creating health impact in terms of health promotion and disease prevention and control. This goal is a process and systems goal, fully recognizing that the quest for better quality health care and services is a continuing or unending process. This is also an expanded goal, aimed to cover the entire health sector, not only the public health or government sections of the sector. Intermediate (5 – year) Goal (2003 – 2007)

To improve the quality of health care in outpatient health facilities, hospitals, and the public health services in the communities. In specific terms, this goal will be carried out by establishing specific quality criteria and by targeting (a) to raise the average quality of out – patient care, hospital care and community / public health care; and (b) to reduce the variation around the average quality of care among these different categories of providers and services. Specific Goal: To improve the quality of outpatient health care (public and private) and of public health services in communities.

For 2003 – 2007, SS will put emphasis on improving the quality of services in local government health facilities and of public health services in communities. Objectives for 2003 – 2007, Phase II Sentrong Sigla Certification has the following objectives for 2003 – 2007, Phase II: By 2007, 1. To establish an efficient systems of providing technical and other forms of assistance to outpatient health facilities, of assessing health services against established criteria, and of monitoring key indicators in the Ss certification process. 2.

To progressively raise the average quality of public health services through recognition of successful attainment of quality standards:  At least 50% of health centers in the country successfully meet the revised SS Phase II Basic Certification (Level I) standards. At least 20% of Level I certified health centers successfully meet SS Phase II Specialty Award (Level 2) standards for all four core public health programs (child care, maternal care / family planning, prevention and control of infectious diseases, and promotion of healthy lifestyle. 3. To raise public awareness of, public support and demand for, and client participation in SS certification of their health services and facilities.

Overall Certification Process

Minimum input, process and output standards for integrated public health services for 4 core programs, facility systems, regulatory functions and basic curative services. Level 2| Specialty Award| Second level quality standards for selected public health programs (includes other health programs in addition to Level 1 core programs) and facility systems. Highest level quality standards for maintaining Level 2 standards for the 4 core public health programs and Level 2 facility systems for at least 3 consecutive years. | All the local health centers and rural health units are qualified to apply for Level I certification. Only those that passed the Level I can go to Level 2; only those that passed the Level 2 can proceed to Level 3.

The certification process starts with participatory self – assessment at the local health facility level assisted by the DOH Representative to the area. Then, for a period of about 3 – 6 months, depending on the deficiencies noted, the local health facility will have to improve its systems and services to meet the quality standards for the appropriate level. DOH Representatives and other regional technical staff shall assist the LGU in this transformation process, providing appropriate technical packages and other assistance as needed.

Multi – sector Regional SS Assessment Teams that have been trained and certified as assessors shall conduct formal assessments using the appropriate Facility Certification Form. These teams will then recommend the certification of health facilities that successfully meet the standards criteria. Major Steps for SS Certification Step 1: Orientation and invitation. Step 2: Self – assessment by LGU. Step 3: Provision of technical assistance. Step 4: Formal assessment for Level 1, Basic Certification.

Step 5: Maintenance of Level 1; working for Level 2 certification. Step 6: Formal assessment for Level 2 certification. Step 7: maintenance of Levels 1 and 2; working for Level 3 certification. Step 8: Formal assessment for Level 3 certification. Step 9: Maintenance of Level 1, 2, and 3 | The above strategy is designed to promote the continuing progression of health facilities towards higher quality levels. The pace of progress towards higher levels depends on the motivation of the health facilities.

However, should health facilities not actively apply for certification into the next higher levels after 2 years, renewal of their SS certification status would be validated by Regional Assessors every 2 years.

Recognition for Level 3 Award of Excellence shall be given at the national level. Matching grants shall be a mechanism to provide assistance to LGUs to achieve basic SS Certification and to continue to attain higher levels of quality. Region – specific procedures to assess needs and motivation shall guide prioritization of such grants. Facilities that did not progress into higher level certification after 2 years, but maintained their current certification status based on Regional validation, shall be given stickers confirming the renewal of the validity of their SS status.

Validation shall be done every 2 years. There shall be no other incentives for mere renewal of SS status. Grants for technical assistance towards attaining higher level quality, however, may still be granted by the respective CHDs based on thorough assessment of the needs and the commitment of the health facility. The SS Certification Flow Chart Procedures 1. 0. Technical Assistance 2. 1. Self – assessment and planning This process is participatory involving all key staff of the health facility, other units of the local government and the local executive.

The DOH Representative to the area is the primary technical assistant of the DOH. He / She shall ensure that the LGU has all the necessary documents and materials needed for the certification and that all key LGU staff understands the standards and processes involved. The DOH Rep shall either provide actual technical inputs or tap other regional resource person and technical services to assist his / her LGU. Based on the QSL, The LGU, assisted by their DOH Rep, shall conduct a system and services analysis and shall formulate a plan, synchronized with the DOH Rep‘s assistance plan, to achieve the standards in the QSL. . 2. Designing and providing technical package Based on the improvement plan, the DOH Rep shall provide the technical inputs and packages. 2. 3. Systems improvement Improving the quality of systems, such as logistics and information systems, are better facilitated through field exposure in facilities that demonstrate model systems or by bringing in resource persons knowledgeable in systems analysis and systems improvements. These special arrangements are possible through the DOH Rep and regional TA teams.

Assessment Quality Standards for SS Phase II Level 1 (Basic Certification) The 78 SS Phase II Level 1 standards are organized into 4 sections: integrated public health programs, facility systems, regulatory functions, and basic curative services. Integrated Public Health Programs. Only four “core” public health programs are currently included in Level 1 Basic Certification in order to focus the services on the most crucial public health priorities in child health, maternal health and family planning, prevention and control of infectious diseases especially tuberculosis, and the promotion of healthy lifestyle.

Integration is stressed to emphasize the need to combine similar and related interventions, such as child targeted programs like EPI, CDD – ARI, nutrition and others, infection prevention and control interventions, maternal care and family planning, and healthy lifestyle approaches. Integration is achieved by ensuring that facility – based services are reinforced by well – planned and well – coordinated, synergistic home – and community – based activities. The synthesized protocols emphasized “proven” interventions, excluding experimental interventions not yet proven to be cost – beneficial or effective such as the syndromic approach to STD.

Note that for Level 1, the program selected is maternal care and family planning, not Women’s Health. This is because there are many developmental and experimental areas in the expanded field. Women’s Health and other programs not in Level 1 Basic Certification are to be included in Level 2 SS. Facility Systems. These standards include systems and services that cut across various programs and support all health facility services. These include planning and budgeting, human resources development, management and health information systems, logistics system, referral system and community systems.

Regulatory Functions. Regulatory functions include two aspects: compliance of the health staff with health laws and the performance of the responsibilities of the local health staff in the enforcement of these health laws. Basic Curative Services. The standards refer to routine history – taking, physical and laboratory examination, and systematic assessment of these signs and symptoms. 3. 5. Quality Standards for Level 2 and 3 ideas and direction These standards are still being developed.

The concept for Level 2 Specialty certification is to define program – centered higher level quality standards for selected programs. The programs include the four core public health services in Level 1 and other programs that include developmental components, for instance women’s health or reproductive health. Level 2 standards would also include higher quality systems standards. Level 3 standards would be very much like Level 2 standards with emphasis on maintenance of these high quality service levels. 3. 6. Tools for Measuring SS Quality Standards

As in any certification process, accurate measurement of the attainment of the quality standards is difficult. The methods of measurement used in SS include direct observation, records reviewand interview of health staff and clients. Of the total 78 standards in the QSL, 53 shall be measured using the Facility Certification Form (FCF). The rest are measured by suing the Supervisory Form, which in turn is also verified through the FCF. Facility Certification Form. The measurement methods include mostly simple direct observation, short review of records and short interviews with either staff or clients.

Supervisory Form. These are taught to the health facility supervisors, mainly the nurses or physicians. The methods included in the SF are the lengthy and more highly technical observations of actual patient care, the more thorough review and analysis of records, and the more detailed interview of staff or clients. The records of the supervisory activities, in turn, are those assessed by the SS Assessor. 3. 7. Scoring The scoring system puts more weight on the integrated public health services and facility systems. The “must have” standards are those listed in the FCF. Nice to have” standards are either in the supervisory form or in the discretionary list for SS assessors. 3. 8. Training and certification of assessors To prevent bias and too wide variation of judgement between assessors, only duly trained assessors will be certified to conduct assessments. Assessor Field Supervisors recruit, train and recommend certification / renewal of certification of assessors in the field teams under them. Advocacy, IEC, and Social Mobilization The table below is the media communication plan for SS listing the basic messages and target groups.

National advocacy activities will focus on wide tri – media popularization of the SS seal and its symbol. Regional advocacy will focus on raising the commitments of local executives to SS and the awareness and demand for quality services among the communities. Target Audience| Messages| Scope: Media| General public(including politicians) | What is SS? What is the SS seal? What are the SS standards? What facilities have to meet these standards? What are the general benefits of having SS certified health facilities?

Reinforce the value of quality in health care. What are the updates on SS? (revisions, etc. )What are the specific benefits of being an SS certified facility? Using the revised SS certification processes, how can the health facility become SS? What are the specific and relevant guidelines for LGU action? | By region & LGU: sales conferences, symposia, meetings, handouts, manuals. | Monitoring, Research and Evaluation

The quality level of each health facility, including the deficiencies of those not yet SS certified, are monitored to detect the increasing average quality level and the needs for assistance. Research is used to develop improved quality standards program components and training packages and top evaluate the SS achievements. Organization and Functions The National Sentrong Sigla Certification Committee (National SSC Committee) sewrves as the multi – sector body that oversees policy recommendations and coordinates the various activities of SS.

This committee also assesses the performance of the various subcommittees and DOH units involved in the implementation of the strategy. The subcommittees of the National SSC Committee with their respective functions are as follows: Sub – Committee on Standards and Procedures 1. Develops and recommends standards and procedures for Sentrong Sigla certification, as well as basic messages to various stakeholders, through multi – sector consultation and pilot – testing and taking into consideration other quality initiatives and accreditation programs of other agencies in the country.

Develops and disseminates guidelines on SS implementation to DOH staff at all levels.  Coordinates training of various stakeholders on standards, procedures and basic messages.  Performs other functions as relevant to the development and dissemination of standards and procedures in SS. Sub – Committee on Technical Assistance and Monitoring Assists the DOH Regional Offices / CHDs in the following functions:Dissemination of SS standards, procedures, guidelines, and basic messages to the other members of the health sector such as the local government units (LGUs) and private practitioners, among others.

Development of training assistance packages, systems and tools that will facilitate the attainment of SS standards. Coordination of various sectors involved in the SS quality assessment of health facilities.  Development of monitoring tools and performance indicators and analysis of the SS results of the database for all health care facilities (certified and not yet certified). Monitoring of the achievement of identified SS program indicators of performance. 6. Identification and coordination of grants and projects that will facilitate the SS certification of target health facilities and systems in the country. . Other functions necessary to assist the LGUs and other members of the health sector in attaining SS quality standards.  Sub – Committee on Advocacy and Awards Designs and recommends revised, graduated incentives scheme that puts emphasis on excellence rather than monetary incentives. Identifies and mobilizes funds and partners in order to deliver these incentives. Develops projects to facilitate SS certification of target health facilities and systems and performs the necessary processes to get these projects approved and implemented efficiently.

Advocates for multi – sector participation in the SS program based on the basic messages developed by the Standards and Procedures Sub – Committee with emphasis on the quality improvement benefits to different sectors involved. Performs other functions necessary to make the SS incentives focused on the excellence and to sustain interest and participation in the certification strategy. Functions of the DOH Regional Offices / CHDs in SS Certification In addition to the technical assistance functions mentioned under the Sub – Committee on Technical Assistance and Monitoring, the DOH Regional Offices shall: 1.

Organize Regional SS Assessment Teams and SS Technical Assistance Team.  Advocate for SS certification within their respective regions. 3. Identify and mobilize resources and partners to help enhance the attractiveness of the SS incentives scheme without putting too much emphasis on monetary or material rewards.  Develop regional projects that will promote and facilitate SS certification and active partnership.  Perform other functions as necessary to implement SS certification and quality improvement activities within the health sector.

National Structure for Sentrong Sigla Certification Regional Structure for SS Certification Financing SS activities are funded from multiple sources. The BLHD provides funds for SS national operations, including national advocacy and the activities of the National SSC Committee. Regional Health Offices provide the funds for regional operations including regional advocacy, matching grants and other rewards such as the SS seals, certificates and trophies. BLHD may augment the funds of regions that seek financial assistance.

BLHD, in coordination with DOH financing units, monitors selected financial indicators for SS certification such as funds allocated and disbursed at all levels, including counterpart funds from LGUs. Future Directions SS Certification is expected to further develop in many directions. The quality standards are expected to reflect higher levels of quality and other changes through the years. Assessors and TAs will have to be retained as these changes are incorporated. New programs and new or revised protocols may be added in the “core” list. Future standards may be developed to cover other units in the LGU and the community.

Within 2007, initiatives shall include preparations for expansion of the coverage of SS certification into private outpatient health facilities and the development of Level 2 and 3 standards. In the future, it is also expected that the Licensing requirements would eventually absorb the “safety” standards currently in SS. PHIC – developed standards for hospital services are expected to become the SS standards for hospitals. Definition of Terms 1. Quality – degree of excellence or desirability of a product, usually measured in relation to conformity with given standard. 2. Quality

Control (QC) – set of functions designed to insure quality in manufactured products by relying on periodic inspection of finished products, analysis of results of inspection to determine causes of defects and systematic removal of such causes. 3. Quality Assurance (QA) – set of functions designed to insure quality in manufactured products by preventive or pre – emptive removal of potential sources of defects through constant improvement of production technology, engineering design, materials, processes, equipment and workmanship. 4. Quality Management (QM) – the organization – wide pursuit of quality. . Quality Improvement (QI) – the broad all – encompassing generic term for processes involve in the continuing pursuit to improve quality. 6. Performance Improvement – a type of QI focused on the systematic and continuing improvement of organizational performance in order to achieve total quality. 7. Total Quality Management (TQM) – the pursuit of quality that involves not just the production organization but also its clients and customers, suppliers and sub – contractors, competitors and oversight agencies in the market, and all other stakeholders in the community. 8.

Total Quality – the ultimate goal in improvement which involves doing the right thing right the first time and all the time while meeting the needs of internal and external stakeholders and customers. 9. 1998 Quality Assurance Program – refers to DOH quality program formulated in 1998 that is focused on improving the DOH – LGU partnership to provide quality health services. The QAP started the certification and recognition strategy for improving health services in health centers, rural health units and baranggay health stations. The Sentrong Sigla Movement replaced the QAP. 10.

Sentrong Sigla Movement – the term used in 1999 to refer to the 1998 QAP. The SSM is essentially the same as the 1998 QAP, with some minor revisions like the inclusion of local hospitals in the certification and the listing of 4 pillars to support the process. This term was also used to refer to other quality – related concepts such as the quality improvement philosophy, the multi – sector nature of CQI, and the value changes in CQI. The Philippine QIH Program replaced the SSM. 11. QIH Program – refers to the Philippine Quality in Health Program, the current quality improvement program (AO 17 – B s. 003) that replaced the QAP and the SSM. The QIH has expanded the scope of the quality initiatives to involve the entire health sector, not only the DOH and the LGU services, and now includes the licensing and other efforts such as accreditation by PHIC or other professional societies in its strategies. 12. Sentrong Sigla Certification – refers to the strategy of assessing health facilities against established health services criteria and recognizing those that successfully meet the criteria. The certification process is expected to lead to changes in the health facility when they strive to meet the criteria. 13.

SS Quality Standards List (QSL) – the list of basic SS criteria to be met by health facilities. In SS Phase II, the QSL for Level 1 certification includes input, process and output criteria. 14. SS Facility Certification Form (FCF) – the form that is used in the formal assessment of health facilities. The FCF contains standards that will be measured by the SS Assessor and the method by which these will be measured. It also works as the scoring sheet. 15. Supervisory Form (SF) – the form used by the health facility supervisor (the nurse or the physician) in assessing the capability of his / her health staff, usually midwives.

This contains the standards that are measured mostly through direct observation of provider – client interactions and in depth review and analysis of records. 16. Inputs – the resources needed to provide care or services such as staff, equipment and supplies. 17. Processes – a series of activities or tasks. 18. Outcomes – the result of the processes. Conclusion In 2001, according to the World Bank, “The quality of service varies between different types of health facilities with the facilities providing better quality of service to be more heavily utilized by the individuals from the higher income groups.

Public health facilities such as the rural health units and barangay health stations are generally perceived to provide low quality health services. Few have emphasized the quality of services and most systematic efforts to improve based on findings about the delivery process have been limited to health facilities with adequate resources. ” Everybody deserves to receive quality health care. Whether you came from the poorest of the poor or the richest of the rich, there should be a same level of quality care. Sadly, here in the Philippines, the quality of health care services and management system has been widely deficient.

With this in mind, quality improvement in health system needs to be organized systematically to bring about genuine health systems reform. We should change the general perception that the Philippines have fragmented planning, funding, and management of the quality initiatives. And in order to achieve this – thus achieving quality health care – there should be coordination and collaboration between the government, NGOs, and the community. And it shouldn’t stop there. In order to achieve excellence in health services, it should be remembered that the quest for quality health care is continuous.

Honestly, I’m not really aware what Sentrong Sigla Movement is. I don’t know what it is for, how was it being implemented, etc. Because of the limited knowledge I have, and the lack of information and resources, I have decided to visit DOH and ask for information. I have learned that the Sentrong Sigla Movement has been stopped in the year 2007, and only reached the Level 2 where trainings have been conducted but there was no implementation. It is stopped because of the PHIC Bench Book, where it is just the same as the Sentrong Sigla Movement, because the DOH also included most of the inputs in the said proposal.

Unfortunately, it is still not being implemented, thought it has been revised and just waiting for the sign and review of the Secretary of DOH. I guess, the lack of funds has a major impact why an important program such as Sentrong Sigla was being stopped. But I am sure that there will be always a quest for excellence in providing health care services. I wish that there will come a time that it will not matter if you’re in a public or private hospital for they are providing same quality care.

Nevertheless, we should remember that the success of quality initiatives lies in producing change the way people and organization work rather than concentrating standards and measurement alone.

Bibliography

•  Cuevas, F. P. , Reyala, J. , Borja, V. , Serafica, L. , Manlangit, C. , Mendoza, M. T. , Ramos, L. , Ruzol, C. , Soliman, R. , Aricheta, J. , Garfin, A. M. C. , Niola, R. , Bocobo, M. , Hipolito, H. (2007). Public Health Nursing in the Philippines 10th Edition.
• http://www. doh. gov. ph/sentrong_sigla

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