PHILIPPINE HEALTH AGENDA 2010-2022 - COMMUNITY HEALTH NURSING

GOALS
The Health System we aspire for:
1. Financial protection
 Filipinos, especially the poor, marginalized, and vulnerable are protected from high cost of health
care
2. Better Health Outcomes
 Filipinos attain the best possible health outcomes with no disparity
3. Responsiveness
 Filipinos feel respected, valued, and empowered in all of their interaction with the health system

VALUES
The Health System we aspire for:
1. Equitable & Inclusive to All 3. Transparent & accountable
2. Uses resources efficiently 4. Provides high quality services
During the last 30 years of Health Sector Reform, we have undertaken key structural reforms and continuously
built on programs that take us a step closer to our aspiration.
Milestone:
 Devolution  fiscal autonomy for government hospitals
 Use of Generics  Good Governance Programs (ISO, IMC,
 Milk Code PGS)
 Phil health (1995)  Funding for UHC
 DOH resources to promote local health
system development

PERSISTENT INEQUITIES IN HEALTH OUTCOMES

1. Every year, around 2000 mothers die due to pregnancy-related complications.
2. A Filipino child born to the poorest family is 3 times more likely to not reach his 5th birthday, compared
to one born to the richest family.
3. Three out of 10 children are stunted.

Restrictive and Impoverishing Healthcare Costs

1. Every year, 1.5 million families are pushed to poverty due to health care expenditures
2. Filipinos forego or delay care due to prohibitive and unpredictable user fees or co-payments
3. Php 4,000/month healthcare expenses considered catastrophic for single income families
Poor quality and undignified care synonymous with public clinics and hospital
1. Long wait times 4. Privacy and confidentiality taken lightly
2. Limited autonomy to choose provider 5. Poor record-keeping
3. Less than hygienic restrooms, lacking 6. Overcrowding & under-provision of care
amenities.

ALL FOR HEALTH TOWARDS HEALTH FOR ALL

(Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat)
AMBISYON NATIN 2040 (Duterte’s Administration)

ATTAIN HEALTH-RELATED SDG TARGETS

Financial Risk Protection | Better Health Outcomes | Responsiveness
Values: Equity, Quality, Efficiency, Transparency, Accountability, Sustainability, Resilience
3 Guarantees:
1. Service delivery A C H I E V E
2. All life stages and triple burden
3. Universal Health Insurance

GUARANTEE 1
• ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE
COMMUNICABLE DISEASES NONCOMMUNICABLE DISEASES OF RAPID
 HIV/AIDS DISEASES & URBANIZATION &
 TB MALNUTRITION INDUSTRIALIZATION
 Malaria  Cancer  Injuries
 Diseases for Elimination  Diabetes  Substance abuse
 Dengue  Heart Disease and their  Mental Illness
 Leptospirosis Risk Factors – obesity,  Pandemics
 Ebola virus smoking, diet, sedentary  Travel Medicine
 Zika virus lifestyle  Health consequences of
climate change / disaster

SERVICES FOR BOTH THE WELL & THE SICK

 Pregnant  Child
 Newborn  Adolescent
 Infant  Adults
  Elderly  food & micronutrient supplementation
 First 1000 days  Immunization
 Reproductive and sexual health  Adolescent health
 maternal, newborn, and child health  Geriatric Health
 exclusive breastfeeding  Health screening, promotion & information

GUARANTEE 2 SERVICE DELIVERY NETWORK

 Functional Network of Health Facilities
Guarantee 2: Services are delivered by networks that are:
 FULLY FUNCTIONAL (Complete Equipment, Medicines, Health Professional)
 COMPLIANT WITH CLINICAL PRACTICE GUIDELINES
 AVAILABLE 24/7 & EVEN DURING DISASTERS (911)
 PRACTICING GATEKEEPING
 LOCATED CLOSE TO THE PEOPLE (Mobile Clinic or Subsidize Transportation Cost)
 ENHANCED BY TELEMEDICINE

GUARANTEE 3 UNIVERSAL HEALTH INSURANCE

 Financial Freedom when Accessing Services
Guarantee 3: Services are financed predominantly by PhilHealth
PHILHEALTH AS  100% of Filipinos are members
THE GATEWAY  Formal sector premium paid through payroll
TO FREE  Non-formal sector premium paid through tax subsidy
AFFORDABLE
CARE
SIMPLIFY  No balance billing for the poor/basic accommodation & Fixed co-payment
PHILHEALTH for non-basic accommodation
RULES
PHILHEALTH AS  Expand benefits to cover comprehensive range of services
MAIN REVENUE  Contracting networks of providers within SDNs
SOURCE FOR
PUBLIC HEALTH
CARE
PROVIDERS

STRATEGY: (A C H I E V E)
A Advance quality, health promotion and primary care
1. Conduct annual health visits for all poor families and special populations (NHTS, IP, PWD,
Senior Citizens)
 2. Develop an explicit list of primary care entitlements that will become the basis for licensing
and contracting arrangements.
3. Transform select DOH hospitals into mega-hospitals with capabilities for multi-specialty
training and teaching and reference laboratory.
4. Support LGUs in advancing pro-health resolutions or ordinances (e.g. city-wide smoke-free
or speed limit ordinances)
5. Establish expert bodies for health promotion and surveillance and response
C Cover all Filipinos against health-related financial risk
1. Raise more revenues for health, e.g. impose health promoting taxes, increase NHIP premium
rates, and improve premium collection efficiency.
2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with PhilHealth.
3. Expand PhilHealth benefits to cover outpatient diagnostics, medicines, blood and blood
products aided by health technology assessment.
4. Update costing of current PhilHealth case rates to ensure that it covers full cost of care and
link payment to service quality.
5. Enhance and enforce PhilHealth contracting policies for better viability and sustainability.

H Harness the power of strategic HRH development

1. Revise health professions curriculum to be more primary care-oriented and responsive to local
and global needs.
2. Streamline HRH compensation package to incentivize service in high-risk or GIDA areas.
3. Update frontline staffing complement standards from profession-based to competency-based.
4. Make available fully-funded scholarships for HRH hailing from GIDA areas or IP groups.
5. Formulate mechanisms for mandatory return of service schemes for all heath graduates
I Invest in Health and data for decision-making
1. Mandate the use of electronic medical records in all health facilities.
2. Make online submission of clinical, drug dispensing, administrative and financial records a
prerequisite for registration, licensing and contracting.
3. Commission nationwide surveys, streamline information systems, and support efforts to
improve local civil registration and vital statistics.
4. Automate major business processes and invest in warehousing and business intelligence tools.
5. Facilitate ease of access of researchers to available data
E Enforce standards, accountability and transparency
1. Publish health information that can trigger better performance and accountability.
2. Set up dedicated performance monitoring unit to track performance or progress of reforms
V Value all clients and patients, especially the poor, marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all health programs and support them in non-
direct health expenditures
2. Make all health entitlements simple, explicit and widely published to facilitate understanding,
& generate demand.
3. Set up participation and redress mechanisms.
4. Reduce turnaround time and improve transparency of processes at all DOH health facilities.
5. Eliminate queuing, guarantee decent accommodation and clean restrooms in all government
hospitals.
E Elicit multi-sectoral and multi-stakeholder support for health
1. Harness and align the private sector in planning supply side investments.
2. Work with other national government agencies to address social determinants of health.
3. Make health impact assessment and public health management plan a prerequisite for initiating
large-scale, high-risk infrastructure projects.
 4. Collaborate with CSOs and other stakeholders on budget development, monitoring and
evaluation

PRIMARY HEALTH CARE (PHC)

1. BRIEF HISTORY
 May 1977. The 30th World Health Assembly adopted resolution which decided that the main
social target of governments and of WHO should be the attainment by all the people of the world
by the year 2000 a level of health that will permit them to lead a socially and economically
productive life.
 September 6-12, 1978. International Conference in PHC was held in this year at Alma Ata, USSR
(Russia).
 October 19, 1979. The President of the Philippines (Ferdinand Marcos) issued Letter of
Instruction (LOI) 949 which mandated the then Ministry of Health to adopt PHC as an approach
towards design, development, and implementation of programs which focus health development
at the community level.
PHC Rationale
Adopting primary health care has the following rationales:
 Magnitude of Health Problems
 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other development activities
PHC Objectives
1. Improvement in the level of health care of the 5. Extension of essential health services with
community priority given to the underserved sectors.
2. Favorable population growth structure 6. Improvement in basic sanitation
3. Reduction in the prevalence of preventable, 7. Development of the capability of the
communicable and other disease. community aimed at self- reliance.
4. Reduction in morbidity and mortality rates 8. Maximizing the contribution of the other
especially among infants and children. sectors for the social and economic
development of the community.
There are two types of primary health care workers in the Philippines:
1. Barangay Health Worker or Village Health Worker
2. Intermediate level Primary Health Worker
Four Pillars
1. Active Community Participation 3. Use of appropriate technology
2. Intra and Inter-sectoral linkages 4. Support mechanism made available
MAJOR STRATEGIES
A. Elevating health to a comprehensive and sustained national effort.
Will require the following:
 Expanding participation in health and health-related programs whether as service provider or
beneficiary.
 Empowerment to parents, families and communities to make decisions of their health is the desired
outcome.
 Advocacy must be directed to national and local policy making to elicit support and commitment
to major health concerns through legislations, budgetary and logistical considerations.
B. Promoting and supporting community managed health care
The health in the hands of the people brings the government closest to the people.
 It necessitates a process of capacity building of communities and organization to plan, implement
and evaluate health programs at their levels.
C. Increasing efficiency in health sector
 Using appropriate technology will make services and resources required for their delivery,
effective, affordable, accessible and culturally acceptable.
 The development of human resources must correspond to the actual needs of the nation and the
policies it upholds such as PHC.
 The Department of Health (DOH) continue to support and assist both public and private
institutions particularly in faculty development, enhancement of relevant curricula and
development of standard teaching materials.
D. Advancing essential national health research
 Essential National Health Research (ENHR) is an integrated strategy for organizing and managing
research using intersectoral, multi-disciplinary and scientific approach to health programming and
delivery.
2. LEGAL BASIS
 October 19, 1979 – Letter of Instruction (LOI) 949, the legal basis of PHC was signed by Pres.
Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and
implementation of programs focusing on health development at community level.
3. DEFINITION
 The WHO defines Primary Health Care an essential health care made universally acceptable to
individuals and families in the community by means acceptable to them through their full
participation and at a cost that the community and country and afford at every stage of
development.
4. GOALS
The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving
that goal:
 Reducing exclusion and social disparities in health (universal coverage reforms);
 Organizing health services around people’s needs and expectations (service delivery reforms);
  Integrating health into all sectors (public policy reforms);
 Pursuing collaborative models of policy dialogue (leadership reforms); and
 Increasing stakeholder participation.
5. Elements

PRINCIPLES & STRATEGIES

Primary health care is run with the following principles:
1. 4 A’s = Accessibility, Availability, Affordability and Acceptability, Appropriateness of health services.
 The health services should be present where the supposed recipients are. They should make
use of the available resources within the community, wherein the focus would be more on
health promotion and prevention of illness.
2. Community Participation
 Community participation is the heart and soul of primary health care.
3. People are the center, object and subject of development.
1. So, it means that the success of any undertaking that aims at serving the people is dependent on
people’s participation at all levels of decision-making; planning, implementing, monitoring and
evaluating.
2. Any undertaking must also be based on the people’s needs and problems (PCF, 1990)
3. Part of the people’s participation is the partnership between the community and the agencies found
in the community; social mobilization and decentralization.
4. As a whole, health work should start from where the people are and building on what they have.
Example: Scheduling of Barangay Health Workers in the health center
BARRIERS OF COMMUNITY INVOLVEMENT
1. Lack of motivation
2. Attitude
3. Resistance to change
4. Dependence on the part of community people
5. Lack of managerial skills
 4. Self-reliance
 Through and community participation cohesiveness of people’s organization they can generate
support for health care through social mobilization, networking and mobilization of local
resources. Leadership and management skills should be developed among these people. Existence
of sustained health care facilities managed by the people is some of the major indicators that the
community is leading to self-reliance.
5. Partnership between the community and the health agencies in the provision of quality of life
 Providing linkages between the government and the non-government organization and people’s
organization
6. Recognition of interrelationship between the health and development
 Health is defined as not merely the absence of disease. Neither is it only a state of physical and
mental well-being. Health being a social phenomenon recognizes the interplay of political, socio-
cultural and economic factors as its determinant. Good Health therefore, is manifested by the
progressive improvements in the living conditions and quality of life enjoyed by the community
residents.
 Development is the quest for an improved quality of life for all. Development is multidimensional.
It has political, social, cultural, institutional and environmental dimensions (Gonzales 1994).
Therefore, it is measured by the ability of people to satisfy their basic needs,
7. Social Mobilization
 It enhances people’s participation or governance, support system provided by the government,
networking and developing secondary leaders.
8. Decentralization
 This ensures empowerment and that empowerment can only be facilitated if the administrative
structure provides local level political structures with more substantive responsibilities for
development initiators. This also facilities proper allocation of budgetary resources.

Core principles & components for effective implementation of primary health care.

A. LEVELS OF PREVENTION
Prevention
 Is about avoiding disease before it starts.
  It has been defined as the plans for, and the measures taken, to prevent the onset of a disease or other
health problem before the occurrence of the undesirable health event.
There are three distinct levels of prevention.
 Primary prevention — those preventive measures that prevent the onset of illness or injury before the
disease process begins.
o Examples include immunization and taking regular exercise.
 Secondary prevention — those preventive measures that lead to early diagnosis and prompt treatment of
a disease, illness or injury to prevent more severe problems developing. Here health educators such as
Health Extension Practitioners can help individuals acquire the skills of detecting diseases in their early
stages.
o Examples include screening for high blood pressure and breast self-examination.
 Tertiary prevention—those preventive measures aimed at rehabilitation following significant illness. At
this level health services workers can work to retrain, re-educate and rehabilitate people who have already
developed an impairment or disability.
Health Education can be applied at all three levels of disease prevention and can be of great help in maximizing
the gains from preventive behavior.
 For example, at the primary prevention level — you could educate people to practice some of the
preventive behaviors, such as having a balanced diet so that they can protect themselves from developing
diseases in the future.
 At the secondary level, you could educate people to visit their local health center when they experience
symptoms of illness, such as fever, so they can get early treatment for their health problems.
 At the tertiary level, you could educate people to take their medication appropriately and find ways of
working towards rehabilitation from significant illness or disability.

C. UNIVERSAL HEALTH CARE (UHC)

Definition: Universal health coverage (UHC) means that all people and communities can use the promotive,
preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective,
while also ensuring that the use of these services does not expose the user to financial hardship.
1. Legal Basis
 It is a time for celebration in the Philippines. President Rodrigo Block quote_UHC law story-
01Duterte has just signed a Universal Health Care (UHC) Bill into law (Republic Act No. 11223)
that automatically enrolls all Filipino citizens in the National Health Insurance Program and
prescribes complementary reforms in the health system.
 This gives citizens access to the full continuum of health services they need, while protecting them
from enduring financial hardship as a result.
2. Background and Rationale
 UHC is firmly based on the WHO constitution of 1948 declaring health a fundamental human right
and on the Health for All agenda set by the Alma Ata declaration in 1978. UHC cuts across all of
the health-related Sustainable Development Goals (SDGs) and brings hope of better health and
protection for the world’s poorest.
3. Objectives and Thrusts
The definition of UHC embodies three related objectives:
a. Equity in access to health services - everyone who needs services should get them, not only
those who can pay for them;
b. The quality of health services should be good enough to improve the health of those
receiving services; and
c. People should be protected against financial-risk, ensuring that the cost of using services
does not put people at risk of financial harm.