| Summary, etc. |
The Ifugao General Hospital (IGH) is located in the town of Lagawe, the capital of Ifugao province in the Philippines. Ifugao is a landlocked province in the Cordillera Administrative Region in the island of Luzon. The terrain is rugged since it is located within the Cordillera Mountain Ranges. About 30% of the barangays are considered "Geographically Inaccessible and Disadvantaged Areas" (GIDA). Because of the inaccessibility of these areas, it was a common sight to see non-ambulatory patients being transported to the IGH through hammocks. Ifugao has a total population of about 200,000. Lagawe, its capital town, is a fourth class municipality with a population of about 20,000. IGH was established in the 1950s Kiangan, the old capital of the province. It was a simple dispensary which catered to the local townsfolk. The facility was transferred to Lumingay Street, Poblacion West in Lagawe in the 1970s. In the early 1980s, it was relocated to its third site in Sitio Natuwolan in Barangay Cudog as a 25-bed then 50-bed capacity hospital until it became a secondary of Level 2, 75-bed capacity hospital, and served as the provincial hospital of Ifugao province. The Chief of Hospital then was Dr. Luis Genato. The hospital catered to patients coming from the eleven municipalities of the province. In addition, IGH also served patients coming from the nearby provinces of Nueva Vizcaya, Mountain Province, and Benguet. It was the end-referral health facility of 11 Rural Health Units (RHU) and six District Hospitals (DH). The most common causes of consultation and admissions were diseases of the respiratory, cardiovascular, and gastrointestinal systems. Accidents, cancers, degenerative or lifestyle-related diseases, infectious diseases, maternal and child health illnesses, and deliveries were also common reasons for consulting clients. In 2014,the hospital had to be closed because the Department of Health Cordillera Administrative Region (DOH-CAR) Regional Licensing and Enforcement Division (RLED) noted that IGH had not been compliant with the standard of the physical plant of the building. With multiple cracks seen in the floor, walls, columns and beams of the building, the structural integrity of the building was questionable. The cracks were said to be increasing in number because of soil movement under the hospital building. Its License to Operate was not renewed thereafter. Subsequently, upon the recommendation of the Chief of RLED, the Regional Director issued a Cease and Desist Order for IGH to stop its hospital operation (SOE, 2014). Currently, the old building of IGH is functioning as the Provincial Health Office (PHO) Clinic wth 24/7 Outpatient services offering consultation and ancillary services such as X-ray, laboratory and pharmacy services. It is being supervised by Dr. Joseph Bulayungan, the Chief of Hospital. Seeing the need for a new hospital, construction of a new building in Barangay Poblacion West in Lagawe under the Health Facility Enhancement Program (HFEP) was slated in 2009. However, the construction was unsuccessful because of internal and external factors which affected its phases of pre-implementation, implementation and post-implementation. The project did not materialize as it was envisioned by its stakeholders. Nonetheless, this should not be considered as a total failure because there are management and leadership lessons that can be learned from it. This paper aimed to preserve tacit knowledge, analyze what went wrong during the pre-implementation, implementation and post-implementation phases, and propose management solutions to prevent a similar occurence. During the post-implementation phase, the scholar could only discuss about the status of IGH after the project had been terminated. Lessons on the importance of good planning, budgeting, procurement and costing during the pre- implementation phase were equally important as the lessons learned during the implementation phase. Deficient planning and budgeting were noted in areas where there are documents lacking such as: geological hazard maps from the Mines and Geosciences Bureau (MGB) of the Department of Environment and Natural Resources (DENR); approved design together with the Detailed Architectural and Engineering Design (DAED); and the Program of Work (POW) prepared by an accredited and qualified architect and engineering firm. Planning for infrastructure should not only focus on financial planning but must also include the determination of resources required for the project such as timelines, materials, suppliers, as well as human resources needed to complete the project. There was inadequate planning because there was no project plan aside from the POW and DAED. In this case the contractor of Phase I did not hand over the Project Plan to the Phase 2 contractor. The Project Plan covered the scope of the project, milestones, work schedule and breakdown structure (tasking), and progress tracking. The community people were not also consulted in the conceptualization of this facility. The setting up of governance structures like a Project Management or Project Monitoring Team and a Project Engineer to look solely on the implementation of the project was missing. Moreover, the Regional Project Monitoring and Evaluation System (RPMES) of the Regional Development Council (RDC) did their monitoring and already noted that there are structural issues raised in Phase 1 that were not addressed. In the implementation phase, the "Last Touch" policy in infrastructure taught us that there should be only one contractor for the different phases of construction. This contractor would have ownership, accountability, and responsibility for the project. The leaders of the Central, Regional and Local Government Units should have been more proactive, firm, and steadfast in their decision-making. They should have not been easily influenced by negative publicity, political intervention, disparaging posts and bullying on social media, as well as death threats which in this case eroded the self-esteem of all concerned parties in the implementation of the project. This case shows HFEP as a big capital investment of the government that is not properly used to improve the health of the people. Lessons from the Strategic Public Management Module specifically Applied Public Sector Economics (APSE) and Understanding Public Finance revealed that there was no allocative and technical efficiency in handling the HFEP Project in IGH. Likewise, the Procurement Law, the Commission on Audit (COA) rules and regulations, and Internal Audit rules and regulations were allegedly not observed, thus causing further delay in the project implementation. The "U" Theory of Change by Otto Scharmer was the guiding principle that was adopted to introduce change in IGH. During the dialogue with the stakeholders, we were committed to achieve our common goal of continuing the construction and realization of IGH as a safe, client-centered, environment-friendly, and state of the art health facility that provide quality services. After we had experienced and uncovered the current and previous reality that is IGH, we now desire to achieve our preferred reality, which is to have better health systems, better mindsets and better processes for IGH. Like the mythical Phoenix, IGH will rise above its ashes of controversy and of mismanagement through the renewed vigor and commitment of all the stakeholders. |