If we go back to Baguio City’s history as a hill station where the Americans sent their soldiers to heal from tuberculosis when there was no available treatment for TB before World War II, we will find out that the city already had a social role to be a place to heal and to rest. This calling needs to be reclaimed and sustained for the current and future generations.
How the Covid-19 transformed Baguio’s health system
In 2020, while the city government was in the process of drawing the map to revitalize the city, the Covid-19 pandemic happened. It has transformed the world of health, and the world of prevention and control of various diseases is transforming before our eyes, bringing with it unique opportunities while simultaneously providing novel challenges.
With this, we failed to predict exactly what type of technology will exist in the future, but it will have an impact on the way we prepare the future health system – to protect the next generation. Therefore, our responses to this unknown transformation must evolve in an inclusive and human-centered way.
This unpredictability confirmed that the “VUCA” world has invaded the health care system. VUCA stands for volatile, uncertain, complex, and ambiguous world, which describes the constant unpredictable change initially seen in the industrial and business sectors.
The health sector was not spared. Emerging diseases, new scientific knowledge that change evidences in medical care, disruptive technologies, innovations, and health informatics, information, misinformation and disinformation explosion, patients’ increasing expectations, and demands to the health care system are just some of the proofs that the VUCA world is inevitable.
Wading through unchartered terrain and the UHC
As we all know, the health sector’s agenda is reflected in Republic Act 11223 or the Universal Health Care (UHC) Law. As we are all in the process of localizing the UHC law, all citizens are enjoined to travel with this “adventure” since we are all entering an uncharted terrain.
What is in store for us in a “UHC-sized” world?
This world is anchored on the health systems building blocks:
Health human resources, with a skill mix enough to meet manpower and complement standards;
Digital innovations, to manage medical records with data privacy as its guiding principle to be expanded to the city-wide health system to analyze, predict, and prescribe recommendations for decision-making, moving away from traditional context for decision-making; and
Expansion of primary care services, including laboratory and X-ray services and provision of essential drugs and medicines based on needs and demands.
To ensure effective, efficient, and affordable delivery of health services, the reconstitution of the expanded City Health Board was revitalized on October 2019. This will serve as the institutional mechanism for providing oversight, supervision, and sounding board for policy reform in the health services management and delivery systems.
A management support unit has been created to assist the City Health Board in pursuing the identified key result areas of the UHC implementation in the city and in the creation and opening of a Special Health Fund as provided for by the UHC Act.
Mix of leadership skills, revised city charter
While the Covid-19 exposed a lot of inadequacies and uncertainties in all countries and cities, it became a venue for mass testing of leadership across all levels of governance – from top to bottom, side to side, and bottom up. The question is: Will Republic Act 11689, or the Revised Charter of the City of Baguio address the city’s concerns post-pandemic?
I would love to say, “Let’s build the plane while flying it.” Travelling in a VUCA world needs a mix of leadership skills – a paradigm shift in management and governance.
There should be transformative leadership that embraces new paradigms in healthcare management, one that builds partnership outside the health sector, and has transparency and good governance at its core.
We need a responsive leadership ready to embrace technology without compromising patient’s safety. We also need a legacy leadership that strives for quality in service improvement.
We need to have a caring leadership that creates an environment where everyone in the organization feels valued, supported, appreciated, and heard.
Most importantly, there must be strategic leadership, where leaders have the ability to review and change plans when called upon.
Before the pandemic, the seven-point agenda of Mayor Benjamin Magalong served as the beacon towards the city’s vision of addressing the social determinants of health. The pandemic may have set back some of the city’s health initiatives, but it has made the resolve clearer, that this event is definitely a challenge but also more of an opportunity to work for a sustainable future.
Primary health care
We go back to where it started in 1978 in the Alma Ata (Kazakhstan) Declaration on Primary Health Care that there is no universal health care without primary health care. The World Health Organization said primary health care is defined as a whole-of-society approach to effectively organize and strengthen health systems to bring services for health and wellbeing closer to communities.
It has three components: Integrated health services to meet people’s health needs throughout their lives; addressing the broader determinants of health through multi-sectoral policy and action; and empowering individuals, families, and communities to take charge of their own health.
Open spaces and parks, community-based Zumba, making the walkable also bikeable, having smoke-free and vape-free environment, having equitable services especially among the vulnerable sectors; having anti-obesity programs, mental health, and wellness support groups; urban gardening, and a meatless-Sunday policy, are just the foretaste of what the City of Baguio has envisioned, all of which are aiming to address underlying social determinants of health, which is the very core of the Alma Ata Declaration.
Among the strategies are creating a supportive environment to address social determinants of health, expanding health services horizontally and vertically; developing a digital public health system to collect and analyze data as basis to deliver targeted services; and having collaboration between the city government and the private sector.
Early detection of diseases is the heart of primary prevention. But before we can detect, we need infrastructure, technology, innovations manned by highly competent health workers whose passion, and compassion need to be fueled by medical armamentarium.
Baguio as center for health and wellness
The super health center built in Aurora Hill is a testimony and a foresight of how Baguio will be in the future and is a way to regain its calling as a “center for health and wellness” in the Cordillera, as what Baguio was more than 100 years ago.
The current administration has approved 23 health-related policies through ordinances, resolutions, executive orders, terms of partnerships, and memoranda of agreements or understandings, and RA 11689, which is strategic to support the pillars of the city’s health system.
It is a proof that the “no silo rule” works. These policies have foresight – all are aimed at ensuring an effective, efficient, and affordable delivery of health services framework that fosters a whole-of-system, whole-of-government, whole-of-society, and people-oriented approaches. — Donnabel Tubbera-Panes¢