WEEK-2 OVERVIEW OF THE PUBLIC HEALTH IN THE PHILIPPINES

HEALTH CARE DELIVERY SYSTEM

INTRODUCTION TO HEALTH CARE DELIVERY SYSTEM accordance with each country’s needs and
capacities
THE HEALTH CARE DELIVERY SYSTEM
2. Shaping the research agenda and stimulating
“A nation’s health care delivery system has a tremendous the generation, translation, and
impact not only the health of its people but also on their total disseminating valuable knowledge
development including their socioeconomic status “ • 5 Goals Strategy on Research for Health
→ Capacity- in reference to capacity-
FACTORS THAT INFLUENCE THE HEALTH CARE DELIVERY
building to strengthen the national
SYSTEM:
health research system
1. Health care “reforms” → Priorities – to focus research on priority
2. Demographics health need particularly in low and
3. Globalization middle income countries
4. Poverty and growing disparities → Standards - to promote good research
5. Social disintegration practice and enable the greater sharing
of research evidence, tools, and
HEALTH SYSTEM
materials
“consists of all organizations, peoples, and actions whose → Translation - to ensure that quality
primary intent is to promote, restore, or maintain health" evidence is turned into products and
policy
6 HEALTH SYSTEM COMPONENTS
→ Organization – to strengthen the
1. Service delivery research culture within WHO and
2. Health workface improve the management and
3. Information coordination of WHO research activities.
4. Medical products, vaccines, and technologies 3. Setting norms and standards and promoting
5. Financing and monitoring their implementation
6. Leadership and governance or Stewardship. 4. Articulating ethical and evidence-based
policy options
HEALTH ORGANIZATION
5. Providing technical support, catalyzing
WORLD HEALTH ORGANIZATION (INTERNATIONAL) change, and building sustainable
institutional capacity
“provides global leadership on health matters.”
MILLENNIUM DEVELOPMENT GOALS
Department of Health (National)
“operating mechanism to meet the priority needs and service
• United Nations Millennium Declaration “The
requirements of their communities” “primary responsibility is world leaders recognized their collective
Basic Health Services” responsibility to uphold the principles of human
dignity, equality and equity at the global level.”
WORLD HEALTH ORGANIZATION • 8 MDG’s:
• ESTABLISHED April 7, 1948 1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education.
• OBJECTIVE: The attainment of all peoples of
3. Promote gender equality and empower
the highest possible level of health
women.
• 5 CORE FUNCTIONS
4. Reduce child mortality. Target: reduce by
1. Providing leadership on matters critical to
2/3, between 1990 and 2015, the under-five
health and engaging partnerships where
mortality rate.
joint action is needed. Providing technical
5. Improve maternal health. Target:
collaboration with member states with
Annotated by: A. Balloran
 WEEK-2 OVERVIEW OF THE PUBLIC HEALTH IN THE PHILIPPINES
HEALTH CARE DELIVERY SYSTEM
- Reduce by three quarters the maternal → DOH Mission - “to guarantee equitable, sustainable
mortality ratio and quality health for all Filipinos, especially the
- Achieve universal access to reproductive poor, and to lead the quest for excellence in health.”
health MAJOR ROLES
6. Combat HIV/AIDS, malaria and other
diseases. Targets: 1. Leader in health
- Have halted by 2015 and begun to 2. Enabler and capacity builder
reverse the spread of HIV/AIDS 3. Administrator of specific services
- Achieve by 2010, universal access to
CORE VALUES
treatment for all those who need it
- Have halted by 2015, and begun to 1. Integrity
reverse the incidence of malaria and 2. Excellence
other major diseases. 3. Compassion and respect for human dignity
7. Ensure environmental sustainability 4. Commitment
8. Develop a global partnership for 5. Professionalism
development 6. Teamwork
7. Stewardship
PHILIPPINE HEALTH CARE DELIVERY SYSTEM
LEVELS OF HEALTH CARE DELIVERY
DOH | DEPARTMENT OF HEALTH
CLASSIFICATION SCHEME OF HEALTH FACILITIES
→ “the main governing body of health services in the
country” HOSPITAL OTHER HEALTH FACILITIES
→ “provides guidance and technical assistance to LGUs General A. Primary Care
through the center for health development in each of • Level 1 Facilities
the 17 regions" • Level 2 B. Custodial Care
• Level 3 Facility
→ Provincial governments are responsible for (teaching/training C. Diagnostic/
Therapeutic
administration of provincial and district hospitals.
Facility
→ Municipal and city governments are in charge of
specialty D. Specialized
primary care through rural health units (RHUs) or Outpatient Facility
health centers.
→ Satellite outposts known as barangay health stations
(BHSs) provide health services in the periphery of the OTHER HEALTH FACILITIES CATEGORIES:
municipality or city.
➢ Category A | Primary Health Care Facility
3 Major Groups Financing Health Services “a first contact health care facility that offers basic
service including emergency services and provision for
1. The Government (National And Local) normal deliveries”
2. Private Sources
3. Social Health Insurance 1. Without in-patient beds
- ex. Health Centers, out-patient clinics and
DEPARTMENT OF HEALTH / DOH
dental clinics
→ “the national agency mandated to lead the health 2. With in-patient beds - a short-stay facility where the
sector towards assuring quality health care for all patient spends on the average of one to two days
Filipinos” before discharge.
→ DOH Vision - “is to be a global leader for attaining - ex. Infirmaries and birthing (lying-in)
better health outcomes, competitive and responsive facilities
health care system, and equitable health financing.” ➢ Category B | Custodial Care Facility

Annotated by: A. Balloran

 WEEK-2 OVERVIEW OF THE PUBLIC HEALTH IN THE PHILIPPINES
HEALTH CARE DELIVERY SYSTEM
•“a health facility that provides long-term → “one rural health physician to a population of 20,000”
care, including basic services like food
ROLES AND FUNCTIONS OF MHO
and shelter, to patients with chronic
conditions requiring ongoing health and 1. Administrator of the RHU
nursing care due to impairment and a 2. Prepares the municipal health plan and budget
reduced degree of independence in 3. Monitors the implementation of basic health
activities of daily living, and patients in services
need of rehabilitation.” 4. Management of the RHU staff
• Ex: Custodial health care facilities, 5. Community physician
substance/drug abuse treatment and 6. Conducts epidemiological studies
rehabilitation centers, sanitaria, 7. Formulates health education campaigns on
leprosaria, and nursing homes. disease prevention
➢ Category C | Diagnostic/Therapeutic Facility 8. Prepares and implements control measures or
• “a facility for the examination of the rehabilitation plan
human body, specimens from the 9. Medico-legal officer f the municipality.
human body for the diagnosis,
LOCAL HEALTH BOARDS
sometimes treatment of disease or
water for drinking analysis.” → “Code A 7160 provided for the creation of the
➢ Category D | Specialized Outpatient Facility Provincial Health Board and the City/Municipal Health
• “a facility that performs highly boards, or Local Health Boards“
specialized procedures on a outpatient → “enable local governments to attain their fullest
basis.” development as self-reliant communities and make
them more effective partners in the attainment of
• Ex: Dialysis clinic, ambulatory surgical
national goals“
clinic, cancer chemotherapeutic
center/clinic, cancer radiation facility, FUNCTION
and physical medicine and rehabilitation
1. Proposing to the Sanggunian annual budgetary
center/clinic.”
allocations for the operation and maintenance of
RURAL HEALTH UNIT health facilities and services within the
province/city/municipality;
→ “a.k.a. Health Center”
2. Serving as an advisory committee to
→ “a primary level health facility in the the Sanggunian on health matters; and
municipality” 3. Creating committees that shall advise local
→ “preventive and promotive health services” health agencies on various matters related to
→ “supervision of BHSs” health service operations.
→ “1 RHU: 20,000 populations “ HEALTH REFERRAL SYSTEM
→ A referral is a set of activities undertaken by a
health care provider or facility in response to its
inability to provide the necessary health
intervention to satisfy a patient’s need
→ A functional referral system is one that ensures
RURAL HEALTH UNIT PERSONNEL the continuity and complementation of health
MUNICIPAL HEALTH OFFICER (MHO) OR RURAL HEALTH
and medical services.
PHYSICIAN → It usually involves movement of a patient from
the health center of first contact and the hospital
→ “heads the health services at the municipal level” at first referral level.
Annotated by: A. Balloran
 WEEK-2 OVERVIEW OF THE PUBLIC HEALTH IN THE PHILIPPINES
HEALTH CARE DELIVERY SYSTEM
Two-way Referral System GOALS AND OBJECTIVES

• Internal referrals – occur within the health 1. Better health outcomes

facility; may be made to request for an opinion 2. Sustained health financing, and
or suggestion, co-management, or further 3. A responsive health system by ensuring that all
management or specialty care. Filipinos, especially the disadvantaged group,
have equitable access to affordable health care.
• External referral – is a movement of a patient
STRATEGIC THRUSTS
from one health facility to another. It may be
1. Financial risk protection through expansion in
vertical, where the patient referral may be from
NHIP enrollment and benefit delivery
a lower to a higher level of health facility or the
2. Improved access to quality hospitals and health
other way round.
care facilities
INTER-LOCAL HEALTH ZONE 3. attainment of the health-related MDGs
SIX STRATEGIC INSTRUMENTS
→ “an integrated health management & delivery system
1. Health financing - instrument to increase
based on a defined administrative & geographical
resources for health that will be effectively
area”
allocated and utilized to improve the financial
→ “has a defined catchment population within a defined
geographical area, it has a central or core referral protection of the poor and the vulnerable
hospital and a number of primary level facilities such sectors.
as RHUs and BHSs.” 2. Service delivery – instrument to transform the
health service delivery structure to address
ILHZ COMPONENTS variations in health service utilization and health
• People Although WHO has described the ideal outcomes across socioeconomic variables.
population size of a health district between 3. Policy, standards, and regulation – instrument
100,000 and 500,000, the number of people may to ensure equitable access to health services,
vary from zone to zone, especially when taking essential medicines, and technologies of assured
into consideration the number of LGUs that will quality, availability and safety.
decide to cooperate and cluster. 4. Governance for health – instrument to establish
• Boundaries Clear boundaries between ILHZs the mechanisms for efficiency, transparency,
establish accountability and responsibility of and accountability, and prevent opportunities
health service providers. for fraud.
• Health facilities RHUs, BHSs, and other health 5. Human resources for health – instrument to
facilities that decide to work together as an ensure that all Filipinos have access to
integrated health system and a district or professional health care providers the
provincial hospital, serving as the central referral appropriate level of care.
hospital. 6. Health information – instrument to establish a
• Health workers To deliver comprehensive modern information system that shall:
services, the ILHZ health workers include a. Provide evidence for policy and program
personnel of the DOH, district or provincial development;
hospitals, RHUs, BHSs, private clinics, volunteer b. Support for immediate and efficient
health workers from NGOs, and community provision of health care and management of
based organizations. province-wide health systems.
HEALTH SECTOR REFORM: UNIVERSAL HEALTH CARE PUBLIC HEALTH PROGRAMS
→ “a.k.a. Aquino Health Agenda” 1. Reproductive and maternal health: pre-
→ “Health Sector Reforms are intended to bring pregnancy services and care during pregnancy,
about equity in health service delivery” delivery, and postpartum period
Annotated by: A. Balloran
 WEEK-2 OVERVIEW OF THE PUBLIC HEALTH IN THE PHILIPPINES
HEALTH CARE DELIVERY SYSTEM
2. Expanded Garantisadong Pambata (child • Accessibility - distance/travel time required to
health): advocacy for exclusive breastfeeding in get to a health care facility/services.
the first 6 months of life, newborn screening → the home must be w/in 30 min. from the
program, immunization, nutrition services, and Brgy.health stations
integrated management of childhood illness. • Affordability - consideration of the individual,
3. Control of communicable disease such as family, community and government can afford
tuberculosis, mosquito-borne diseases, rabies, the services
schistosomiasis, and sexually transmitted → the out-of-pocket expense determines
infections the affordability of health care.
4. Control of noncommunicable or lifestyle → in the Philippines, government
diseases insurance is covered
5. Environmental health through PhilHealth
PRIMARY HEALTH CARE • Acceptability - health care services are
“the essential care made universally accessible to individuals compatible with the culture and traditions of the
and families in the community through their full preparation .” population.
• Availability - is a question whether the health
UNIVERSAL GOAL service are offered in health care facilities or is
→ “Health For All by the Year 2000” provided on a regular and organized manner.
→ ”this is achieved through community and
individual self-reliance” Support Multisectoral Community
5 KEY ELEMENTS Mechanism Approach participatio
1. Reducing exclusion and social disparities in n
3 major 1. Intrasectoral a process in
health (universal coverage).
resources: linkages which
2. Organizing health services around people’s
1. People (Two - way people
needs and expectations (health service reforms). 2. Governm referral sys.) identify the
3. Integrating health into all sectors (public policy ent — problems
reforms). 3. Private communicati and needs
4. Pursuing collaborative models of policy dialogue Sectors on, and assumes
(leadership reforms). (e.g. cooperation responsibiliti
5. Increasing stakeholder participation. NGO, and es
8 ESSENTIAL HEALTH SERVICES church…) collaboratio themselves
E - Education for health n within the to plan,
L - Locally endemic disease control health manage, and
E - Expanded program for immunization sectors. control.
M - Maternal and child health including 2. Intersectoral
Linkages -
responsible parenthood
between the
E - Essential drugs
health sector
N - Nutrition and other
T - Treatment of communicable and sectors like
noncommunicable diseases education,
S - Safe water and sanitation agriculture
KEY PRINCIPLES and local
gvn. officials.
4 A’s :

Annotated by: A. Balloran

 WEEK-2 OVERVIEW OF THE PUBLIC HEALTH IN THE PHILIPPINES
HEALTH CARE DELIVERY SYSTEM
3. POULTRICE - directly apply plant material on the
EQUITABLE DISTRIBUTION OF HEALTH RESOURCES affected part, usually in bruises, wounds and
rashes.
2 DOH programs to ensure equitable distribution 4. TINCTURE - mix the plant material in alcohol.
Medicinal Use/ medication Preparation
1. Doctor to the Barrio (DTTB) Program
plants
• the deployment of doctors to
municipalities that are w/o doctors. Asthma, cough and colds, Decoction
fever, dysentry, pain
• deployed to unserved, economically Lagundi Wash affected
depressed 5th or 6th class municipalities Skin disease (scabies, site with
ulcer, eczema), wounds decoction
for 2 years.
2. Registered Nurses Health Enhancement and Headache, stomachache Decoction
Local Service (RN HEALS) Yerba Buena
Cough and colds Infusion
• training and program for unemployed
nurse Rheumatism, Asthritis Massage sap
Sambong Antiedema/antiurolithiasis Decoction
• deployed to unserved, economically
depressed municipalities for 1 year. Tsaang Gubat
Diarrhea
Decoction
APPROPRIATE TECHNOLOGY Stomachache
Niyog-niyogan Antielminthic Seeds are used
Health technology includes:
Washing wounds
• tools Bayabas Decoction
• drugs Diarrhea, gargle,
toothache
• methods Akapulko Antifugal Poultrice
• procedures and technique
Ulasimang Bato/ Lowers blood uric acid Decoction
• people’s technology Pansit-pansitan (rheumatism and gout)
• indigenous technology Eaten raw
Criteria for Appropriate Health Technology Hypertension, lowers
Eaten raw/fried
Bawang blood cholesterol
• Safety
Apply on part
• Effectiveness Toothache
• Affordability Diabetes mellitus (mild Decoction
Ampalaya
• Simplicity non-insulin-dependent)
Steamed
• Acceptability
• Feasibility and Reliability
• Ecological effects ALTERNATIVE HEALTH CARE MODALITIES
• Potential to contribute to individual and
Term Definition
community development
- application of pressure on
R.A. 8423 | Traditional and Alternative Medicine Act of Acupressure acupuncture pts. w/o puncturing the
1997 skin
- uses special needles to puncture
Medicinal Plant Preparation Acupuncture and stimulate specific part of the
1. DECOCTION - boiling the plant material in water body
for 20 min. - combines essential aromatic oils to
Aromatherapy
then applied to the body
2. INFUSION - plant material is soaked in hot water
for 10 - 15 minutes.
Annotated by: A. Balloran
 WEEK-2 OVERVIEW OF THE PUBLIC HEALTH IN THE PHILIPPINES
HEALTH CARE DELIVERY SYSTEM
-“nutritional healing”, this improves
Nutritional health by enhancing the nutritional
therapy value to reduce the risk of the
disease
- follows the principle of balancing
Pranic Healing
energy
- application of pressure on the
Reflexology body’s reflex joints to enhance
body’s natural healing.

PRIMARY CARE

• “includes health promotion, disease prevention,

health maintenance, counseling, patient education
and diagnosis and treatment of acute and chronic
illness in different health settings”
• “refers to the first contact of a person with a
professional”
• “a model of nursing care that emphasizes continuity
of care”
• “nursing care is directed towards meeting all the
patient’s need”

PHC PC
Focus of client family and individual
community

Focus of care promotive and curative

preventive

Decision- community- health worker

making process centered driven

Outcome self-reliance reliance on health

workers

Setting for rural-based mostly urban

services satellite clinics; places; hospital,
community clinics
health centers

Goal development and absence of

preventive care disease

Annotated by: A. Balloran