CHAPTER II

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

HEALTH CARE SYSTEM

Is the totality of service offered by all health disciplines. The major purpose of delivery system was to provide care to ill and injured.

MAJOR PLAYERS:
PUBLIC SECTOR
Which is largely finance through a tax based budgeting system at both national and local levels. And were Health care is generally given free at the point of service.

Consist:
National and Local government agencies providing health services. It also contains provincial health teams made up of DOH representatives to the local health boards and personnel.

PRIVATE SECTOR Largely market oriented and where Health care is paid through user fees at the point of service.

Consists:
For profit and non-profit health providers. It includes providing health services in clinics and hospitals, health insurance, manufacture of medicine, vaccine, medical supplies, equipment and other health and nutrition products, research and development, human resource development and other health related services.

Historical Background of DOH

Pre-spanish and spanish periods

Traditional health care practices specially the used of herbs and rituals for healing were widely practiced during this period. JUNE 23,1898- the DPWEH was created by virtue of a decree signed by president Emilio Aguinaldo. SEPTEMBER 29,1898- With the primary objective of protecting the health of American soldiers Gen. Orders No.15 established the board of health for city of Manila.

JUNE 1,1901- Board of health for the Philippine Islands was crated through Act No. 157.This functioned as the local health board of Manila. OCT.26,1905- The insular board of health proved to be inefficient operationally so it was abolished and was replaced by the Bureau of health under the Department of Interior through Act No. 1407 1912- Act No. 2156 known as Fajardo Act, consolidated the municipalities into sanitary division and established as the Health Fund for travel and salaries

1915- Act No.2468 transformed the Bureau of health into a commissioned service called The Philippine Health Service. AUG.2,1916- The passage of the Jones Law also known as the Philippine Autonomy Act, filipino struggle for Philippine Independence from the American rule. 1932- Act No. 4007 known as the Reorganization Act. Of 1932, reverted back the Philippine service into Bureau of Health, and combined the Bureau of public welfare.

PHILIPPINE COMMONWEALTH AND JAPANESE OCCUPATION MAY31,1939- Commonwealth Act No.430 created the Department Health and Welfare but the full implementation was only completed through the Exe. Order No.317 1942- During Japanese occupation, various reorganization and issuances for health and welfare were instituted and lasted until Americans came. OCT4,1947- Exe. Order No. 94 provided for the post-war reorganization of the DOH and public welfare

JAN.1,1951- The office of the president of the sanitary district was converted into RHU, carrying out 7 basic health services:
Mother and Child Services Environmental Health Communicable disease control Vital Statistics Medical Care Health Education Public Health Nursing

FEB.20,1958- Exe. Order No. 228 Provided for what is prescribed as the most sweeping reorganization in the history of DOH. 1970- The RHCDS was conceptualized. Classified Health services into primary, secondary and tertiary level of care. JUNE 2,1978-With the proclamation of Martial Law, Pres. Decree 1397 renamed the DOH to MOH. DEC.2,1982- Exe. Order No. 851 signed by president Ferdinand Marcos reorganized the ministry of health as an integrated HCDS.

APR.13,1987- Exe. Order No. 119 Reorganizing the ministry of health by president Aquino saw in major change in the structure of the ministry. Transformed the MOH back to DOH. OCT.10, 1991- R.A. 7160 known as the LGC provided for the decentralization of the entire government. This brought about major shift in the role and functions of DOH. MAY24, 1999- Exe. Order No. 102 redirecting the functions and operations of the DOH by president Estrada granted the DOH to proceed with its rationalization and streamlining plan.

1999-2004- Development of HSRA which described the major strategies, organizational and policy changes and public investment needed to improve the way health care is delivered, regulated and finance. 2005 ongoing- Development of a plan to rationalize the bureaucracy in an attempt to scale down including the DOH.

National authority on health providing technical and other resource assistance

Three Specific Roles In the Health Sector

Leadership in Health

Enabler and Capacity Builder

Administrator of Specific Services

Leadership in Health
Serve as the national policy and regulatory institution. Provide leadership in the formulation Serve as advocate in the adoption

Enabler and Capacity Builder

Innovate new strategies in health, initiate public discussion, disseminate policy research outputs. Exercise oversight functions Ensure the highest achievable standards of quality.

Administrator of Specific Services

Manage selected national facilities and hospitals with modern facilities. Administer direct services for emergent health concerns Administer health emergency response services

Vision and Mission

Vision The DOH is the leader, staunch advocate and model in promoting Health for All in the Philippines.
Mission
Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health

Goal: Health Sector Reform Agenda

Sound organizational Development Strong Policies Systems and Procedures Capable Human Resources Adequate Financial Resources

Rationale for Health Sector Reform

Following Conditions

Slowing down in the reduction Persistence of large variations in health status High burden Rising burden Unattended emerging health risks Burden of disease

Factors Affecting the Conditions:

Inappropriate Health delivery system Inadequate regulatory mechanisms for health services Poor health care financing

Implications
There is poor coverage There is inequality access There is low and high quality cost

Framework for Implementation of HSRA: FOURmula ONE for Health

Intends to implement critical interventions as a single package backed by effective management infrastructure and financing arrangements following a sectorwide approach.

Goals of FOURmula ONE for Health

Better health outcomes More responsive health systems Equitable health care financing

Four elements of the Strategy

1. 2. 3. 4.

Health financing Health Regulation Health service delivery Good governance

Key features of the FOURmula ONE

Engagement of the National Health Insurance Program (NHIP) as the main lever to effect desired changes and outcomes in each of the four implementation components

NHIP supports each of the elements in term of:

1. 2. 3. 4.

Financing Governance Regulation Service Delivery

Roadmap for All Stakeholders in Health: National Objectives for Health 2005-2010

NOH 2005-2010 Provides the road map for skateholders in health and health-related sectors to intensify and harmonize their efforts to attain its timehonored vision of health for all Filipinos Sets the targets and the critical indicators, current strategies based on field experinces, and laying down new avenues for improved interventions

Provides concrete handle that would guide policy makers, program managers, local government executives, development partners, civil society and the communities in making crucial decisions for health

Objectives of the Health Sectors

A. B. C. D. E.

Improve the general health status of the population Reduce morbidity and mortality from certain diseases Eliminate certain diseases Promote healthy lifestyle and environmental health Protect vulnerable groups with speacial health and nutrition needs

F. Strengthen national and local health systems to ensure better health service delivery G. Pursue public health and hospital reforms H. Reduce the cost and ensure the quality of essential drugs I. Institute health regulatory reforms to ensure quality and safety of health goods and services

J. Strengthen health governance and management support systems K. Institute safety nets for the vulnerable and marginalized systems L. Expand the coverage of social health insurance M. Mobilize more resources for health N. Improve efficiency in the allocation, production and utilization of resources for health

LOCAL HEALTH SYSTEM

Historical background 1. Post war independence Philippine Health Care System was administered by a central agency based in Manila 2. 1992 - Major shift took place in the Local Government Code also known as Republic Act 7160. LGU runs the local health systems

Objectives
Establish local health systems for effective and efficient delivery of health care services Upgrade the health care management and service capabilities of local health facilities Promote inter-LGU linkages and cost sharing schemes Foster participation of the private sector, nongovernment organization (NGOs) and communities in local health systems development

Ensure the quality of health service delivery at the local level

Inter Local Health Systems

Being espoused by the DOH in order to ensure quality of health care service at the local level. A system of health care similar to a district health system in which individuals, communities and all other health care providers in a well-defined geographical area

Expected Achievement of the Inter-Local Health System

Universal coverage of health insurance Improved quality of hospital and Rural Health Units (RHU) service Effective referral system Integrated planning Appropriate Health Information System Improved Drug Management System Developed human resources

Effective leadership through Inter-LGU corporation Financially visible or self sustaining hospitals Integration of public health and curative hospital care Strengthened cooperation between LGU and health services

Guiding Principles In Developing The Inter-Local Health System

Financial and Administrative autonomy of the provincial and municipal administrations (LGUs) Strong political support Strategic synergies and partnerships Community participation Equity of access to health services by the population, especially the poor

Affordability of health services Appropriateness of health programs Decentralized management Sustainability of health initiatives Upholding of standards of quality health service

Composition of the Inter-Local Health Zone

1. 2. 3. 4.

People Boundaries Health Facilities Health Workers

PRIMARY HEALTH CARE

AN APPROACH TO DELIVERY OF HEALTH CARE SERVICES

DEFINITION
PRIMARY HEALTH CARE Is an essential care made accessible to the community through acceptable means

HISTORY

Health for all by Year 2000

Declared during First International Conference on Primary Health Care Held in Alma Ata, USSR Happened on September 6-12, 1978 Organized by the World Health Organization

HISTORY

LETTER OF INSTRUCTION 949 Philippines

HEALTH IN THE HANDS OF PEOPLE BY 2020

Yxw|tw XA `tv
October 19, 1979

HISTORY

Wespite

the

failure to realize the goal of Health for All by 2000, the altruistic endeavor has bear fruit as it has produced progress in the lives of people from the communities it has influenced.

CONCEPTS
PARTNERSHIP + EMPOWERMENT OF PEOPLE = PRIMARY HEALTH CARE

EFFECTIVE ACCESSIBLE ACCEPTABLE SUSTAINABLE

ELEMENTS AND COMPONENTS

1. Environmental sanitation

ELEMENTS AND COMPONENTS

2. Control of Communicable Diseases

ELEMENTS AND COMPONENTS

3. Immunization

ELEMENTS AND COMPONENTS

4. Health Education

ELEMENTS AND COMPONENTS

5. Maternal and Child Health and Family Planning

ELEMENTS AND COMPONENTS

6. Adequate Food and Proper Nutrition

ELEMENTS AND COMPONENTS

7. Provision of Medical Care and Emergency Treatment

ELEMENTS AND COMPONENTS

8. Treatment of Locally Endemic Diseases

ELEMENTS AND COMPONENTS

9. Provision of Essential Drugs

STRATEGIES Reorientation and reorganization of national health care system with the establishment of functional support mechanism.

STRATEGIES

Effective preparation and enabling process for health action at all levels.

STRATEGIES Mobilization of the people to know their communities and identifying their basic health needs.

STRATEGIES Development and utilization of appropriate technology focusing on local indigenous resources available in and acceptable to the community.

STRATEGIES Organization of communities arising from their expressed needs which they have decided to address.

STRATEGIES
Increase opportunities for community participation in local level planning, management, monitoring and evaluation within the context of regional and national objectives.

STRATEGIES Development of intra-sectoral linkages with other government and private agencies.

STRATEGIES Emphasizing partnership so that the health workers and the community leaders/members view each other as partners.

FOUR PILLARS/CORNERSTONES
1. Active community participation 2. Intra and inter-sectoral linkages 3. Use of appropriate technology 4. Support mechanism made available

TYPES OF WORKERS
Available health manpower resources Local health needs and problems Political and financial feasibility

TYPES OF WORKERS
Physician Nurses Midwives Traditional healers Community health workers

LEVELS OF WORKERS
Village or Barangay health workers. Trained community health workers. health auxiliary volunteer. traditional birth attendant or healer

Intermediate level health workers. General medical practitioners or their assistants. Public health nurse. Rural sanitary inspectors and midwives

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM

PRIMARY LEVEL CARE

Devolve to the cities and the municipalities.

SECONDARY LEVEL OF CARE

Is given by the physicians with basic health traning.

TERTIARY LEVEL OF CARE

Is rendered by specialist in health facilities including medical centers as well as regional and provincial hospitals and specialized hospitals.

LEVELS OF HEALTH CARE SERVICES

National Health Services Medical Centers Teaching Hosptials Regional Health Services Regional Medical Centers And Training Hospitals Provincial / City Health Services Provincial / City Hospitals Emergency / District Hospitals Rural Health Unit Community Hospitals and Health Centers Private Practitioners / Puericulture Centers Barangay Health Stations
Levels of Health Care and Referral System

On Duty

Marcelino, Regine Ortua, Justine Pearl Patagoc, Janyss April Pesebre, Johnette Vinluan, Sandi

II-AN