Island of Good Governance Breakthrough is PHC contribution to decrease Mortality due to Heart Disease in the Philippines ( DOH 2009 - 47.5%), sharing the World Heart Federation Roadmap to decrease Mortality for Cardiovascular Diseases by 25% in the next 25 years. A review of the Natural History of disease shows prevention in three (3) areas as shown in the figure below.

Figure 6: CAD Challenge: What To Do 2015-2040

The three outcomes in the Regional Heart Centers that need to be realized as a cardiac center should be three fold.

Table 4: Tertiary Prevention is the IGG BT Objective

To do this, Surgical missions were scheduled in all the regional hospitals since 2013 to indicate that Open and Closed heart surgery can be done. A complete team of 15-20 personnel per mission were sent by the center composed of 3-5 Surgeons on a sliding 2 day trip, 2 Cardiovascular Anaesthesiologists, 2 Perfusionists, 2 Operating Room nurses, 2 Surgical ICU Nurses, 3 Pediatric Cardiology Intensivists, Adult Cardiologists for adult cases , and 2-3 surgical mission staff. PHC also brings all equipment, Operating Room and perfusion supplies where necessary, even bringing a bypass machine and a portable echo machine.

Figure 7: PHC IGG Commitment

The formation of a Multi Sectoral Governance Advisory Council (Heartlink Advisory Council) since September 2014 in PGS was instrumental to make this Strategic Initiative of Satellite hospitals possible. The leadership of PHC sought to formalize and evolve the role of the hospital's old and loyal institutional partners who have contributed to PHC. The MSGC presented itself as the mechanism by which stakeholders partnerships can be formalized and composed of leaders of the following organizations: Mending Kids International, Children's Heart Foundation, and Philippine Airlines. The confidence for holding intra-country missions in the satellite centers was brought out of the opportunity for International Missions of PHC through the Mending Kids International, in Pnom Penh Heart Center in Cambodia, with successful good outcomes in 25-27 children in two missions last December 2013, and June 2014.

In the intra-country missions, MSGC projects and support for patient support and operational expense were carried out through MKI donations of around 7,500 – 15,000 USD per mission (Php 300,000-700,000). Philippine Airlines supported airfare per mission, and Children's Heart Foundation support for hospital bills and PDA devices in its early learning phase helped Pediatric Interventionists hone their skills. To date, PDA device closure took over surgery PDA ligation as the best practice in PDA surgery. After the initial support from Children's heart Foundation, Philippine Charity sweepstakes supported all devices since 2014 , even those in the regional hospital missions. The support for the intra-country missions and devices has been envisioned in the context of learning and training of the local personnel in 3-5 years until sustainability and independence is attained.

After each surgical mission, during which at least five (5) procedures per case are done, the regional hospitals become ready to apply for Philhealth Z-benefit Accreditation. Once approved, patient support for cases will be through Philhealth Z-benefit using the PHC Clinical Pathways. This assures standardization of care with duplicated good outcomes. In the subsequent 3-5 years, surgical outcomes will be monitored, and will give time for the regional hospital to upgrade infrastructure and complete training of personnel. MSGC sponsorships will therefore be for operational expense and more regions can be covered after 5 years.