ORGANIZATIONAL STRUCTURE OF THE PHILIPPINE HEALTH CARE SYSTEM

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM HEALTH CARE SYSTEM - an organized plan of health services (Miller-Keane, 1987) HEALTH CARE DELIVERY - rendering health care services to the people (WilliamsTungpalan, 1981). HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981) - the network of health facilities and personnel which carries out the task of rendering health care to the people. PHILIPPINE HEALTH CARE SYSTEM - is a complex set of organizations interacting to provide an array of health services (Dizon, 1977). COMPONENTS OF THE HEALTH DELIVERY SYSTEM The Department of Health Mandate: The Department of Health shall be responsible for the following: formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs; issuance of rules and regulations, licenses and accreditations; promulgation of national health standards, goals, priorities and indicators; development of special health programs and projects and advocacy for legislation on health policies and programs. The primary function of the Department of Health is the promotion, protection, preservation or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services (E.O. No. 119, Sec. 3). Vision: Health as a right. Health for All Filipinos by the year 2000 and Health in the Hands of the People by the year 2020.

Mission:

The mission of the DOH, in partnership with the people to ensure equity, quality and access to health care: - by making services available - by arousing community awareness - by mobilizing resources - by promoting the means to better health LEVELS OF HEALTH CARE FACILITIES 1. PRIMARY LEVEL OF HEALTH CARE FACILITIES - are the rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units operated by the DOH; puericulture centers operated by League of Puericulture Centers; tuberculosis clinics and hospitals of the Philippine Tuberculosis Society; private clinics, clinics operated by the Philippine Medical Association; clinics operated by large industrial firms for their employees; community hospitals and health centers operated by the Philippine Medicare Care Commission and other health facilities operated by voluntary religious and civic groups (Williams-Tungpalan, 1981). 2. SECONDARY LEVEL OF HEALTH CARE FACILITIES are the smaller, non-departmentalized hospitals including emergency and regional hospitals. - Services offered to patients with symptomatic stages of disease, which require moderately specialized knowledge and technical resources for adequate treatment. TERTIARY LEVEL OF HEALTH CARE FACILITIES - are the highly technological and sophisticated services offered by medical centers and large hospitals. These are the specialized national hospitals. - Services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge, facilities and personnel to treat effectively (Williams-Tungpalan, 1981)

3.

FACTORS ON THE VARIOUS CATEGORIES OF HEALTH WORKERS AMONG COUNTRIES AND COMMUNITIES 1. available health manpower resources 2. local health needs and problems 3. political and financial feasibility

THREE LEVELS OF PRIMARY HEALTH CARE WORKERS A. VILLAGE OR GRASSROOT HEALTH WORKERS - first contacts of the community and initial links of health care. - Provide simple curative and preventive health care measures promoting healthy environment. - Participate in activities geared towards the improvement of the socio-economic level of the community like food production program. - Community health worker, volunteers or traditional birth attendants. B. INTERMEDIATE LEVEL HEALTH WORKERS - represent the first source of professional health care - attends to health problems beyond the competence of village workers - provide support to front-line health workers in terms of supervision, training, supplies, and services. - Medical practitioners, nurses and midwives. C. FIRST LINE HOSPITAL PERSONNEL - provide back up health services for cases that require hospitalization - establish close contact with intermediate level health workers or village health workers. - Physicians with specialty, nurses, dentist, pharmacists, other health professionals.

TWO-WAY REFERRAL SYSTEM (Niace, et. al. 8th edition 1995) A two-way referral system need to be established between each level of health facility e.g. barangay health workers refer cases to the rural health team, who in turn refer more serious cases to either the district hospital, then to the provincial, regional or the whole health care system. Public P Barangay Health O Health Worker Nurse 2nd 3rd P HF HF U EA EA L Barangay RHU AC AC A Health Midwife Physician LI LI T Stations TL TL I HI HI

O N

T RHS Midwife Sanitary Inspector Y

T Y

MULTISECTORAL APPROACH TO HEALTH (NLGNI, 8th edition, 1995) The level of health of a community is largely the result of a combination of factors. Other health-related Systems (government/ private

Ways of The System People (Cultural)

Community Health

Health Care

Environment (Social, Economic, physical, Etc. Health, therefore, cannot work in isolation. Neither can one sector or discipline claim monopoly to the solution of community health problems. Health has now become a multisectoral concern. For instance, it is unrealistic to expect a malnourished child to substantially gain in weight unless the familys poverty is alleviated In other words, improvement of social and economic conditions need to be attended to first or tackled hand in hand with health problems. 1. Intersectoral Linkages - Primary Health Care forms an integral part of the health system and the over-all social and economic development of the community. As such, it is necessary to unify health efforts within the health organization itself and with other

sectors concerned. It implies the integration of health plans with the plan for the total community development. - Sectors most closely related to health include those concerned with: a. Agricultural b. Education c. Public works d. Local governments e. Social Welfare f. Population Control g. Private Sectors The agricultural sector can contribute much to the social and economic upliftment of the people. Demonstration to mothers of better techniques and procedures for food preparation and preservation can preserve the nutritive value of local foods. Through joint efforts, agricultural technology that produces side effects unsafe to health (for instance, insecticide poisoning) can be minimized or prevented. The school has long been recognized as an effective venue for transmission of basic knowledge to the community. Every pupil or student can be tapped for primary health care activities such as sanitation and food production activities.. Construction of safe water supply facilities and better roads can be jointly undertaken by the community with public works. Community organization (e.g. establishing a barangay network for health) can be worked through the local government or community structure. Likewise, better housing through social welfare agencies, promotion of responsible parenthood through family planning services and increased employment through the private sectors can be joint undertakings for healthWe have to recognize that oftentimes health actions undertaken outside the health sector can have health effects much greater than those possible within it. 2. Intrasectoral Linkages - In the health sector, the acceptance of primary health care necessitates the restructuring of the health system to broaden health coverage and make health service available to all. There is now a widely accepted pyramidal organization that provides levels of services starting with primary health and progressing to specialty care. Primary health care is the hub of the health system.

A PYRAMIDAL HEALTH STRUCTURE Tertiary National Health Health Care Services Regional Health Services Secondary Health District Health Services Care Rural (Local Hospital) Services Rural Health Units Primary Barangay Health workers Health Care

THE NATIONAL HEALTH PLAN (Niace, et. al 8th edition 1995) The National Health Plan is the blue print which is followed by the Department of Health. It defines the countrys health problems, policy thrusts, strategies and targets.

POLICY THRUSTS AND STRATEGIES There are policy thrusts and strategies which are commonly important. These are: 1. Information, education, and communication programs will be implemented to raise the awareness of the public, including policy makers, program planners and decision makers; 2. An update of the legislative agenda for health, nutrition and family planning (HNFP), and stronger advocacy for pending HNFP related legislations will be pursued; 3. Integration of efforts in the health, nutrition and family planning sector to maximize resources in the delivery of services through the establishment of coordinative mechanisms at both the national and local levels; 4. Partnership between the public and the private sectors will be strengthen and institutionalized to effectively utilize and monitor private resources for the sector; 5. Enhancement of the status and role of women as program beneficiaries and program implementers will be pursued to enable them to substantially participate in the development process. CONCEPT OF PUBLIC HEALTH 1. Definition of Public Health Winslow described Public Health as the science and art of preventing disease, prolonging life, promoting health and efficiency through organized community effort for a. Sanitation of the environment b. the control of communicable diseases c. the education of individuals in personal hygiene, d. the organization of the medical and nursing service for the early diagnosis and preventive treatment of disease and e. the development of social machinery to insure everyone a standard of living adequate for the maintenance of health 2. Philosophy of Public Health emphasizes the worth and dignity of man Historical Background Pre- Spanish Era no record Spanish Regime (1951-1898) o Bro. Juan Climente (1577) started Public Health Services though a dispensary in Intramuros

o Water sanitation was started o Small pox vaccine was introduced o Positions such as district, provincial, national health officers were created. American Regimen (1898-1942) o 1898 board of health for physician was created o 1899 - the first commissioner of health was appointed o 1906 the board of health was abolished and bureau of health was created o 1912 PHN was started in Cebu with four graduate nurses who dealt primarily in MCH services o 1915 PHN began in Manila with two nurses offered follow up care of OB patients and environmental sanitation services. Japanese regimen( 1942-1945) o PHN service was interrupted Era of the Republic of the Philippines (1946-present) o 1947 DOH was divided into three bureaus hospital, quarantine and health o May 18, 1954 R.A. No. 1082 ( An Strengthening Health and Dental Services in the Rural Areas and Providing Funds Therefor or Rural Health Unit was passed and implemented in July of the same year. It provided for the employment of the health personnel, including nurses, who would man the rural health units ( RHUs) and help raise the health conditions of the rural population. o June 1957 R.A. no. 1891 ( An act to amend section 2,3,4,7, and 8 of R.A. No. 1082 entitled An act strengthening health and dental services in the rural areas and providing funds therefor was approved. o 1975 Formulation of the National Health Plan and the restructured Health Care Delivery System. o 1992 Devolution led to the transfer of authority to LGUs by virtue of the Local Government Code. 3. Principle of the Public Health a. Education concerning prevailing health problems and the methods of preventing and controlling them b. Promotion of food supply and proper sanitation c. Maternal and child healthcare ;including family planning d. Immunization against major infectious diseases e. Prevention and control of locally endemic diseases f. Appropriate treatment of common diseases and injuries g. Provision of essential drugs

4. Roles and Function of the Public Health Nurse

a. Planner/programmer Identifies needs, priorities and problems of the individuals, families, and communities. Formulates municipal health plan in the absence of a medical doctor. Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel. Provides technical assistance to rural health midwives in the health matters. b. Provider of Nursing care Provides direct nursing care to sick or disabled in the home, clinic , school or workplace. Develops the familys capability to take care of the sick, disabled, or dependent member. c. manager/supervisor Formulates individual, family, group and community centered plan. Interprets and implements programs, policies, memoranda and circulars Organizes work force, resources, equipment and supplies at the local level d. community organizer Motivates ad enhance community participation in terms of planning, organizing, implementing, and evaluating health services. Initiates and participates in community development activities. e.Coordinator of services Coordinates with the individuals , families, and groups for health related services provided by various member of the health team. Coordinates nursing program with other health programs like environmental sanitation, health education, dental health, and dental health. f.trainer/health educator

 Identifies and interprets training needs of the Rural health Midwives (RHMs) Barangay Health Workers and hilots. Conducts training for midwives and hilots on health promotion and disease prevention Acts as a resource speaker on health and health related services. Principles of Health Education It consider the health status of the people. It is a process whereby people learn to improve their personal habits and attitudes , to work responsibility for the improvement of the health condition of the family, community, and nation. It should be recognized as the basic function of all health workers. It is a cooperative effort requiring all categories of health personnel to work together in close teamwork with families, groups and the community. It aims to help people make use of their own efforts and education to improve their condition of living It carefully evaluates the planning, organizing, and implementation of all health education programs and activities. g. Health monitor Detect deviation from health practices/behavior of individuals, families, groups and communities through contact/visits with them. h.Role model Provides good example of healthful living to the members of the community. i. Change agent Motivates changes in health behavior lifestyles of individuals, families, groups, and communities in order to promote and maintain health. j. Recorder/Reporter/Statiscian

 Prepares and submit required reports and records. Maintain adequate , accurate and complete recording and reporting. Reviews, validates, consolidates, analyzes and interprets all records and reports. Prepares statistical data/chart and other data presentation k. Researchers Participates in the conduct of survey studies and researchers on nursing and health related subjects. Coordinates with the government and non- government organization in the implementation of studies/research.