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THE NATIONAL HEALTH

SITUATION
THE NATIONAL HEALTH
SITUATION
Demographic profile

- Philippine is one of the populous countries in


the world in 2000.

- 75.3 million (NCSB, 2001)

- projected to increase to 82,636,689 in 2004


(Natioanl Health Objectives, 1999)
THE NATIONAL HELATH
SITUATION
- 1999, average life expectancy at birth was
68.6 years

* 71.28 for females


* 66.03 for males
- 249 people for every square kilometer of
Philippine territory.
THE NATIONAL EHALTH
SITUATION
- Metro manila has the highest population density
(16,051)
- CAR has the lowest (75) (National Health
Objectives).
- from the 37% of the total population in 1984
(unicef, 1986) the figure increased to 44% ten
years later.
- annual population growth rate for the whole
country is 2.3%; urban areas is 3.4 per year.
THE NATIONAL HELATH
SITUATION
- High population density
transmission of infectious and
communicable diseases.

- Greater need for social services such as:


decent housing education
transportation health services
communication
THE NATIONAL HELATH
SITUATION
- High level of stress in congested areas
leads to:
disintegration of moral values and
social institutions and contributes to the
incidence of a number of health problems,
including mental health problems.
THE NATIONAL HELATH
SITUATION
Health profile
Birth and deaths
Crude Birth Rate (CBR) in 1997 was 28.4
per 1000 population
Crude Death Rate (CDR) 6.1 per 1000
population.
The rate of natural increase in the country’s
population for the same year was 22.3
(28.4 minus 6.1) for every 1000 population
THE NATIONAL HELATH
SITUATION
- Rural women have more children than
urban women.
- Uneducated women also have more
children than those who are with college
education.
- Those in the 25-29 age group have the
highest fertility rate (national demographic
and health survey, 1999)
THE NATIONAL HEALTH
SITUATION
In 1995, infant mortality rate (IMR) was
48.9 per 1000 live births, which is within
the WHO global goal for IMR of less than
50/1000 live births.

Under-five mortality rate or deaths of


children below five years old in the same
year was 67/1000 live births.
THE NATIONAL HEALTH
SITUAION
- Maternal mortality rate (MMR) was
1.8/1000 live births (DOH), 1995) or 18
maternal deaths for every 10,000 live
births.

- Death rate among males is higher than


females – referred as the “feminization” of
old age.
THE NATIONAL HEALTH
SITUATION
Causes of morbidity and mortality
Mortality (1997)
3. Diseases of the heart
4. Diseases of the vascular system
5. Pneumonias
6. Malignant neoplasms
7. TB, all forms
THE NATIONAL HELATH
SITUATION
6. Accidents
7. Chronic obstructive and pulmonary
diseases, and allied conditions
8.Other diseases of the respiratory system
9. Diabetes mellitus
10. Diarrheal diseases
THE NATIONAL HELATH
SITUATION
- Infant mortality rate is one of the most
sensitive indicators of health status of a
country or community.
Results from:
1. poor maternal conditions
2. unhealthy environment
3. inadequate health care delivery system
THE NATIONAL HELATH
SITUATION
leading causes of infant mortality in 1997
were:
2. Respiratory conditions of the fetus and
newborn
3. Pneumonias
4. Congenital anomalies
5. Birth injury and difficult labor
6. Diarrheal diseases
THE NATIONAL HELATH
SITUATION
6. Septicemia
7. Measles
8. Meningitis
9. Other diseases of the respiratory system
10. Aminovitaminosis and other nutritional
deficiency. (1997 Philippine health
statistics)
THE NATIONAL HELATH
SITUATION
Maternal mortality – major indicator of a
woman’s health status – define by WHO
as the death of a woman while pregnant or
within 42 days of termination of pregnancy
from any cause related to, or aggravated
by the pregnancy or its management, but
not from accidental or incidental causes.
THE NATIONAL HEALTH
SITUATION
Leading causes of maternal mortality in
1997
1. Normal delivery and other complications
related to pregnancy occurring in the
course of labor, delivery and puerperium.
2. Hypertension complicating pregnancy,
childbirth and puerperium
3. Postpartum hemorrhage
THE NATIOAL HEALTH
SITUATION
4. Pregnancy with abortive outcome
5. Hemorrhages related to pregnancy

Analysis of women’s poor health and


maternal mortality should consider the
overall social, cultural, and economic
environment. (poor, low educational
status, multipara, anemic)
THE NATIONAL EHLATH
SITUATION
Leading causes of morbidity (1997)
2. Diarrheas 7. chickenpox
3. Pneumonias 8. diseases of the
4. Bronchiolitis heart
5. Influenza 9. measles
6. TB, all forms 10. dengue H-fever
7. malaria
THE NATIONAL HEALTH
SITUATION
SARS – “scary” severe acute respiratory
syndrome. Transmission of infectious
diseases is facilitated by the increasing
mobility of people and ease in traveling
form one country to another.
THE NATIONAL HEALTH
SITUATION
AIDS – major public health problem, (urban
areas)
- increase in STD’s (syphilis, & gonorrhea
due to unhampered prostitution in the
country.
- prostitution has always been identified as
a consequence of poverty.
THE NATIONAL HEALTH
SITUATION
TUBERCULOSIS
- Number one cause of mortality about 50
years ago continue to be a major killer of
Filipinos.

LEPROSY
-MDT (multi-drug therapy) 1.7/10,000 (1995)
THE NATIONAL EHALTH
SITUATION
SCHISTOSOMIASIS
- affect hundred of barangays in 24 endemic
provinces.
RABIES
- incidence in the Philippines is one of the highest
in the world.
HEPATITIS B
- 12% of the population are chronic carriers
(hepatitis B and hepatic sarcoma)
THE NATIONAL HEALTH
SITUATION
*MOSQUITO*
- malaria
- filariasis
- dengue fever
THE NATIONAL HEALTH
SITUATION
POVERTY AND HEALTH
- illiteracy
- unfounded health beliefs
- harmful practices
- inadequate nutrition
- poor environmental sanitation
- inadequate source of potable water
supply
NATIONAL HEALTH SITUATION
- congested housing unit
- limited access to basic health services
- inability to make decisions on matters
which are important to health
THE NATIONAL HEALTH
SITUATION
CULTURAL INFLUENCES ON HEALTH
- is a way of life
- passed on from one generation to the
next
- includes beliefs, values and customs or
practices
- traditional
THE ANTIONAL HEALTH
SITUATION
ENVIRONMENTAL INFLUENCES ON
HEALTH
- unsanitary environment = major factor
- breeding ground of animals and insects
that harbor and transmit microorganisms.
- deterioration of the ecosystem
- exposure to chemicals and other air
pollutants (cancer & respiratory diseases)
THE NATIONAL HEALTH
SITUATION
- industrialization
- government policies
- poverty and an uncaring attitude towards
the environment.
THE NATIONAL HEALTH
SITUATION
POLITICAL INFLUENCES ON HEALTH
- politics affects health
- health policies emanate from congress,
the executive department (DOH)
- policies that affect health = health care
delivery system and the practice of
nursing in the Philippines
THE NATIONAL HELATH
SITUATION

- health budget is the most


concrete expression of the
government’s political will.

- health spending has always


THE NATIONAL HELATH
SITUATION
policies that impact
on people’s health
directly
2. National blood
services Act (RA
7719)
3. National diabetes
Act (RA 8191)
4. Salt iodization Act
(RA 8172)
THE NATIONAL HELATH
SITUATION
Policies that affect health indirectly
2. Family and social relationship
3. Environment
4. Access to education
5. Malnutrition
6. Mental health problems
7. Cancer
8. Other lifestyle-related diseases
THE ANTIONAL HELATH
SITUATION
Laws that affect the delivery of health
services
2. Local government code
3. National health insurance Act
4. Professional practice acts of the different
professions
THE NATIONAL HEALTH
SITUATION
THE HEALTH CARE DELIVERY SYSTEM
- is the totality of all policies,
infrastructures, facilities, equipment,
products, human resources, and
concerns of all people
THE NATIONAL HEALTH
SITUATION
- preventive health care = concern of the
government-owned health centers

- curative care = provided by hospitals,


both government and private
THE NATIONAL HEALTH
SITUATION
DEPARTMENT OF HEALTH
- national government’s biggest health
care provider

- used to have control and supervision


over all barangay health stations, rural
health units and hundreds of hospitals
throughout the country
THE NATIONAL HELATH
SITUATION
- Bureau of local health development
- local health systems development
- health care financing programs
- quality improvement programs
- intersectoral (public-private)
coordination and local projects
THE NATIONAL HELATH
SITUATION
DEVOLUTION OF HEALTH SERVICES
- RA 7160 = local government code
- the code aims to: transform local
government units into self-reliant
communities and active partners in the
attainment of national goals through a
more responsive and accountable local
government structure instituted through a
system of decentralization.
THE NATIONAL HEALTH
SITUATION
- provincial, district and municipal hospitals
provincial governments

- rural health units (RHUs) and barangay


health stations (BHSs) municipal
governments
THE NATIONAL HEALTH
SITUATION
- provincial level
> governor (chair)
> provincial health officer (vice chair)
> chairman of the Committee on Health
of the sangguniang panlalawigan
> DOH representative
THE NATIONAL HELATH
SITUATION
- City and Municipal level
> mayor (chair)
> municipal health officer (vice chair)
> chair of the committee on health of the
sangguniang bayan
> DOH representative and NGO
representative
THE NATIONAL HEALTH
SITUATION
HEALTH SECTOR REFORM AGENDA
AND NATIONAL OBJECTIVES FOR
HEALTH
- HSRA (1999-2004)
- NOH (1999-2004)
THE NATIONAL HELATH
STITUATION
FIVE MAJOR REFORMS CONTAINED IN
THE HSRA
2. Provide fiscal autonomy to government
hospitals
3. Secure funding for priority public health
programs
4. Promote the development of local health
systems and ensure its effective
performance
THE NATIONAL HEALTH
SITUATION
4. Strengthen the capacities of health
regulatory agencies
5. Expand the coverage of the National
Health Insurance program
NATIONAL OBJECTIVES FOR
HEALTH

Vision: Health for all Filipinos


NATIONAL OBJECTIVES FOR
HEALTH

Mission: Ensure accessibility and quality


of health care to improve the quality of life
of all Filipinos, especially the poor
NATIONAL OBJECTIVES FOR
HEALTH
Principles
 universal access to basic health
services must be ensured.

 the health and nutrition of vulnerable


groups must be prioritized.
NATIONAL OBJECTIVES FOR
HEALTH
 The epidemiologic shift from infectious to
degenerative diseases must be managed.

 The performance of the health sector must


be enhanced.
NATIONAL OBJECTIVES FOR
HEALTH
 GOALS AND OBJECTIVES
2. Improve the general health status of the
population
- reduce infant mortality rate
- reduce child mortality rate
- reduce maternal mortality rate
- reduce total fertility rate
- increase the life expectancy and the quality of
life years
NATIONAL OBJECTIVES FOR
HEALTH
2. Reduce morbidity, mortality, disability and
complications from the following diseases
and disorders
- pneumonias and acute respiratory
infections
- diarrheas and other food and water
borne diseases like typhoid, cholera, and
hepatitis A
NATIONAL OBJECTIVES FOR
HEALTH
- Tuberculosis
- Dengue
- Intestinal parasitism
- STD’s, HIV-AIDS and other reproductive
tract infections
- Hepatitis B
- Asthma and chronic obstructive
pulmonary diseases
NATIONAL OBJECTIVES FOR
HEALTH
- Nephritis and chronic diseases
- Dental caries and periodontal diseases
- Rheumatic heart disease and rheumatic
fever
- Coronary artery disease, hypertension and
hyperlipidemia
- Stroke
- Cancer
NATIONAL OBJECTIVES FOR
HEALTH
- Diabetes
- Mental disorders
- Protein-energy malnutrition
- Iron-deficiency anemia
- Obesity
- Accidents, traumas and injuries
NATIONAL OBJECTIVES FOR
HEALTH
3. Eliminate the following diseases as public health
problems

- Schistosomiasis
- malaria
- filariasis
- leprosy
- rabies
NATIONAL OBJECTIVES FOR
HEALTH
- vaccine-preventable diseases: measles,
tetanus, diptheria, and pertussis

- Vitamin A deficiency

- Iodine deficiency disorders


NATIONAL OBJECTIVES FOR
HEALTH
4. Eradicate poliomyelitis

5. Promote healthy lifestyle


- promote healthy diet and nutrition
- promote physical activity and fitness
- promote personal hygiene
NATIONAL OBJECTIVES FOR
HEALTH
- promote mental health and less stressful
life

- Prevent smoking and substance abuse

- Prevent violent and risk-taking behaviors


NATIONAL OBJECTIVES FOR
HEALTH
6. Promote the health and nutrition of
families and special populations
- neonatal and infant health
- health of indigenous peoples
- children's health
- adolescent and youth health
- adult health
- women's health
NATIOANL OBJECTIVES FOR
HEALTH
- health of older persons
- health of overseas Filipino workers
- health of differently-abled persons
- health of the rural poor
- health of the urban poor
NATIONAL OBJECTIVES FOR
HEALTH
7. Promote environmental health and
sustainable development
- healthy homes
- healthy workplace and establishments
- healthy schools
- healthy communities, towns and cities
FOURmula ONE FOR HEALTH
FOURmula ONE

implementation framework for health


sector reform
FOURmula ONE FOR HEALTH

 GOALS

 Better health outcomes


 More responsive health systems
 Equitable health care financing
FOURmula ONE FOR HEALTH
FOUR THRUSTS
2. Financing (increased, better and
sustained)
3. Regulation (assured quality and
affordability)
4. Service Delivery (ensured access and
availability)
5. Governance (improved performance)
FOURmula ONE FOR HEALTH
STRATEGIC GUIDEPOSTS
2. Building upon gains and lessons from
major reform initiatives
3. Focus on critical interventions to be
implemented as a single package
4. Sector wide management of
FOURMULA ONE implementation
5. NHP as the primary instrument
FOURmula ONE FOR HEALTH
CONSTRAINTS
2. Restricted government health budgets
- inflexible allocation across categories
- allocation among programs not linked to
performance
5. Difficulty in managing a highly decentralized
system
- steering various stakeholders (i.e. - local
systems, private markets)
- managing health finances from multiple
sources
FOURmula ONE FOR HEALTH
OPPORTUNITIES
2. Deeper understanding of and increasing
leverage of the NHIP over health system
performance.

2. Inroads in health reforms in at least 30


provinces resulting in improvements in health
outcomes and providing invaluable lessons.
FOURmula ONE FOR HEALTH
3. Growing support for HSRA
implementation from partners -
government agencies, external.

4. Deeper understanding of reform


implementation requirements.

5. Revitalized support from national


leadership.
FOURmula ONE FOR HEALTH
CRITICAL COMPONENTS TO JUMP
START fourmula one IMPLEMENTATION
• Identifying critical components
- sufficient groundwork and buy-in
- triggers a chain reaction to spur other
FOURmula ONE interventions
- produces tangible results
- generates public support
FOURmula ONE FOR HEALTH
FINANCING

GOAL

Secure increased, better and sustained


investments in health to improve health
outcomes especially of the poor.
FOURmula ONE….FINANCING
Rationalization of sources of health
financing
* out of pocket
- shift of OOP to outpatient care (e.g.
check-up, consultation, etc.)
* Local government
- focus subsidy on preventive and
promotive health services
FOURmula ONE…FINANCING
*National government
- shift resources on regulation, governance
and to teaching/training tertiary hospitals

*Social health insurance


- Focus on in-patient care
FOURmula ONE…FINANCING
Local health financing reforms
• Earmarking funds and prioritizing health
services

- social marketing advocacy to LGUs, NGO


& private sector to earmark funds for
priority health programs.
FOURmula ONE…FINANCING

- identify tools for prioritizing health


services (e.g. segmentation and
targeting the poor)
FOURmula ONE…FINANCING
*Management/coordination of LGU health
fund
- integrate national and local investment
plan
- cost-sharing arrangements among
LGUs
- national and local coordination of funds
(e.g. counterparting arrangements)
- Rapid estimation of local health
accounts
FOURmula ONE…FINANCING
NATIONAL HEALTH FINANCING
REFORMS
1.Public finance management system
2.Institutionalization of revenue-
enhancement measures
*full retention of income
*asset management
FOURmula ONE…FINANCING
3. Development of efficient and equitable
allocation mechanics.
-priority health programs
-geographic
-income
-population groups
FOURmula ONE…FINANCING
4. Performance based-budgeting system
-develop models for hospitals, public
health and regulatory agencies
-reform financial management and
procurement system
-develop / implement performance audit
and review system
FOURmula ONE…FINANCING
IMPROVEMENT OF THE NHIP
2. Increase membership and collections
3. Enhance benefit package
4. Improve utilization of reimbursements
5. Enhance systems for regulation and
governance
FOURmula ONE…REGULATION
REGULATION

GOAL

Assure access to quality and affordable


health products, devices, facilities and
services especially those used by the
poor.
FOURmula ONE…REGULATION
STRATEGIES
2. Harmonizing & streamlining of systems,
processes for licensing & accreditation and
certification
3. Developing a seal of approval
4. Pursuing cost recovery with income retention
for health regulatory agencies & other revenue
generating mechanisms
5. Ensuring access of the poor to essential health
products
FOURmula ONE…REGULATION
COMPONENTS
Programs include:
3. one-stop shop
4. Philhealth-sentrong sigla seal
5. Unified seal of approval
6. Botika ng barangay / pharma 50
FOURmula ONE…SERVICE
DELIVERY
SERVICE DELIVERY

GOAL

Improve accessibility and availability of


basic and essential health care for all,
especially the poor.
FOURmula ONE…SERVICE
DELIVERY
COMPONENTS
2. Public health development plan
a. disease-free zone – “mopping-up”
leprosy
b. Intensified disease programs - TB,
HIV/AIDS emerging infections
c. Improving reproductive health
outcomes – MMR, IMR, U5MR, TFR,
CPR
FOURmula ONE…SERVICE
DELIVERY
d. Intensified promotion of healthy
lifestyle – DM, HPN, CVD, breast and
cervical cancer, anti smoking, safe water,
sanitation, among others
FOURmula ONE…SERVICE
DELIVERY
2. Health facilities development plan
- critical upgrading of facilities through
fund pool
- rationalizing services in DOH-retained,
local government & private facilities inside
the 16 sites
- Integrating wellness services in
hospitals
FOURmula ONE…SERVICE
DELIVERY
3. Establishment of National Health
Promotion Foundation
4. Disaster preparedness and response
system
5. Disease surveillance and networking
system
6. Intensification of health promotion
FOURmula ONE…SERVICE
DELIVERY
STRATEGIES
1. Making available basic and essential
health service packages by designated
providers in strategic locations

2. Assuring the quality of both basic and


specialized health services
FOURmula ONE…SERVICE
DELIVERY
3. Intensifying current efforts to reduce
public health threats

4. Disease –free zones


a. Filariasis – endemic mapping with STH
and Schistosomiasis programs, disability
prevention
FOURmula ONE…SERVICE
DELIVERY
b. Leprosy – quality diagnosis & case
management

c. Rabies – functional animal bite treatment


centers, responsible pet ownership
FOURmula ONE…SERVICE
DELIVERY
d. Malaria – community participation in
vector control elimination & surveillance
activities. Malaria benefit package
Insecticide Treated Nets (ITN), rapid
diagnostic test.
FOURmula ONE…SERVICE
DELIVERY
e. Schistosomiasis – intensify surveillance of
human cases and the snail vector

5. Intensifies disease prevention and control


a. emerging infectious diseases – avian
influenza task force at all levels,
preparedness & response plan for
pandemic influenza, philhealth benefit
package
FOURmula ONE…SERVICE
DELIVERY
b. VPI – reaching every barangay, 4Bs
(Bakuna, Bitamina A, Breastfeeding
advocacy, purga sa Bulate), 100%
Hepatitis B vaccines till 2010

c. Tuberculosis – nationwide
implementation of DOTS, TB in children
PPMDOTS
FOURmula ONE…SERVICE
DELIVERY
d. HIV / AIDS – social hygiene clinics,
local AIDS councils, behavior change
modification, Community based program,
home base care
FOURmula ONE…SERVICE
DELIVERY
6. Improving reproductive health outcomes
a. Public-private partnership on women’
health
b. Pre-pregnancy package
c. Contraceptive delivery & logistic MIS
d. Standard days method as NFP
e. Paradigm shift – “high-risk” pregnancies
to ALL PREGNANCIES ARE AT RISK
FOURmula ONE…SERVICE
DELIVERY

f. mother and child book


g. infant and young children feeding
program
FOURmula ONE…SERVICE
DELIVERY
7. Intensified promotion of healthy lifestyle
a. tobacco management team at various levels
b. smoking cessation clinics
c. community-based NCD prevention and
control program
d. intensified promotion of healthy lifestyle –DM,
HPN, CVD, breast & cervical cancer, anti-
smoking, safe water, sanitation among others.
e. strengthen national HL campaign
FOURmula ONE…GOVERNANCE
GOVERNANCE

GOAL

Improve health system performance at


the national and local levels
FOURmula ONE…GOVERNANCE
COMPONENTS
1. Sectoral development approach for health
2. Health human resource masterplan
3. Establishment of 4-in-1 convergence sites
4. Philippine health information system
5. Procurement and logistics management
system
6. Public finance management system
FOURmula ONE…GOVERNANCE
Sectoral development approach for health
1. To strengthen government leadership in
implementing a sector program where
development partners cooperate and contribute
accordingly
- effective donor and LGU coordination towards
financing a sector program
- harmonizing procedures among donors and
national government
FOURmula ONE…GOVERNANCE
Health human resource masterplan
2. To maintain a national HHR masterplan
in support of national & local health
systems
- HHR information system
- competency-based recruitment &
selection systems
- training and development need analysis
FOURmula ONE…GOVERNANCE
- Performance management system
- Career development and management
- Advocacy plan
FOURmula ONE…GOVERNANCE
Developing a localized health human
resource strategy
2. Health professional development and
career track
3. Identifying and providing venue for
posting of vacancies
4. Actively promoting LGU vacancies
5. Support for developing local HR strategy
FOURmula ONE…GOVERNANCE
Establishment of 4-in-1 convergence
sites
2. Health investment planning
3. Developing appropriate governance and
mechanisms, i.e., ILHZ convergence
sites
4. Helping mobilizing extra-budgetary
resources for health at the local level
FOURmula ONE…GOVERNANCE
4. Improving procurement, devolving
regulatory functions, linking, local
regulatory policies with health programs
and financing
5. Nationalizing the health delivery network,
provision of basic health services
6. Monitoring & evaluation, i.e., LGU score
card
FOURmula ONE…GOVERNANCE
Philippine health information system
2. establishment, operationalization, & use
of health portal and development of
Philippine health information
infrastructure
- harmonization of info systems
- human resource info system
- vital registries, health statistics
FOURmula ONE…GOVERNANCE
Philippine health information system
2. establishment, operationalization, and
use of health portal and development of
philippine helath information
infrastructure
3. Development of manual of operations
FOURmula…GOVERNANCE
DOH procurement and logistics management
system
2. Inventory system, supply chain mechanism
3. Efficient storage
4. Database of goods / supplies (standard
specifications)
5. Procurement systems
- pooling
- monitoring
- feedback mechanism
FOURmula ONE…GOVERNANCE
- Disease surveillance
- health accounts
- health regulations
- health facilities
FOURmula ONE…GOVERNANCE
5. Database of supplies with performance
monitoring
6. Standardization of specifications and
documents
7. Implementation of ethical practices
framework
THE NATIONAL OBJECTIVES
ON HEALTH
NATIONAL OBJECTIVES…

NATIONAL OBJECTIVES FOR HEALTH 2005


TO 2010
-Provides the road map for stakeholders in health
and health-related sectors to intensify and
harmonize their efforts to attain its time-honored
vision of health for all Filipinos and continue its
avowed mission to ensure accessibility and
quality of life of all Filipinos, especially the poor.
NATIONAL OBJECTIVES…

It 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.
NATIONAL OBJECTIVES…
OBJECTIVES OF THE HEALTH SECTOR
2. Improve the general health status of the
population
3. Reduce morbidity and mortality from certain
diseases
4. Eliminate certain diseases as public helath
problems
5. Promote healthy lifestyle and environmental
health
NATIONAL OBJECTIVES…
5. Protect vulnerable groups with special health
and nutrition needs
6. Strengthen national and local health systems to
ensure better health service delivery
7. Pursue public health and hospital reforms
8. Reduce the cost and ensure quality esssential
drugs
9. Institute health regulatory reforms to ensure
quality and safety of helath goods and services
NATIONAL OBJECTIVES…
10. Expand the coverage of social health
insurance
11. Mobilize efficiency in the allocation,
production and utilization of resources for
health