A.

World Health Organization

1.Millennium Development Goals (MDGs)
The United Nations Millennium Development Goals are eight goals that all 191 UN member
states have agreed to try to achieve by the year 2015. The United Nations Millennium
Declaration, signed in September 2000 commits world leaders to combat poverty, hunger,
disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are
derived from this Declaration, and all have specific targets and indicators.

The Eight Millennium Development Goals are:

1. to eradicate extreme poverty and hunger;

2. to achieve universal primary education;
3. to promote gender equality and empower women;
4. to reduce child mortality;
5. to improve maternal health;
6. to combat HIV/AIDS, malaria, and other diseases;
7. to ensure environmental sustainability; and
8. to develop a global partnership for development.

The MDGs are inter-dependent; all the MDG influence health, and health influences all the
MDGs. For example, better health enables children to learn and adults to earn. Gender equality is
essential to the achievement of better health. Reducing poverty, hunger and environmental
degradation positively influences, but also depends on, better health.

2.Sustainable Development Goals

The Sustainable Development Goals (SDGs) aim to transform our world. They are a call to action to
end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice and
prosperity. It is critical that no one is left behind. In 2015, all the countries in the United Nations
adopted the 2030 Agenda for Sustainable Development. It sets out 17 Goals, which include 169
targets. These wide-ranging and ambitious Goals interconnect.

Target 3.4 is: Goal 3 is to ensure healthy lives and promote well-being for all at all ages. By 2030,
reduce by one third premature mortality from non-communicable diseases through prevention and
treatment and promote mental health and well-being. Within Target 3.4, suicide rate is an indicator
(3.4.2).
B. Philippine Department of Health
1. Mission-Vision
VISION
Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040

MISSION
To lead the country in the development of a productive, resilient, equitable and people-centered health
system.

2. Historical Background

23 June 1898
Creation of the Department of Public Works, Education & Hygiene (now the Department of Public
Works & Highways, Department of Education Culture & Sports, and Department of Health,
respectively) through the Proclamation of President Emilio Aguinaldo.
29 September 1898

Establishment of the Board of Health for the City of Manila under General Orders No. 15.

1899 - 1905

Abolition of the Board of Health and appointment of Dr. Guy L. Edie as the first Commissioner of
Public Health.

Act. No. 157 of the Philippine Commission - creation of the Board of Health for the Philippine
Islands; it also acted as the Board of Health for the city of Manila

Acts Nos. 307, 308 and 309-establishment of the Provincial and Municipal Boards of Health,
completing the health organisation in accordance with the territorial division of the Islands.

Act. No. 1407- (also the "Reorganization Act" ) abolition of the Board of Health and its functions and
activities were taken over by the Bureau of Health.

1906

Passage of Act No. 1487 of the Philippine Commission repealing Act No. 307 wherein the provincial
Board of Health gave way to the Office of the District Health Officer
1912

Passage of Act. No. 2156, so- called "Fajardo Act", which authorized the consolidation of
municipalities into sanitary division and established what is now known as the "Health Fund"

1915

Changing of the name of the Bureau of Health to the Philippine Health Service, which was later on
changed to its former name.

1932

Passage of Act No. 4007, also "the Reorganization Act of 1932", which created the Office of the
Commissioner of Health and Public Welfare, the Philippine General Hospital, and the five
examining boards (medical, pharmaceutical, dental, optical and nursing).

Creation of the Department of Health and Public Welfare as provided for in Executive Order No.
317, series of 1941. The Department was under the Secretary of Health and Public Welfare and also
included the Bureau of Quarantine; the health department of chartered cities; the provincial, city
and municipal hospitals; dispensaries and clinics, the public markets and slaughter houses; the
health resorts; and all charitable and relief agencies. However, the Philippine General Hospital was
detached from the Department and transferred to the Office of the President of the Philippines.

1947

Reorganization of government offices under Executive Order No. 94, series of 1947 with the transfer
of the Bureau of Public Welfare to the Office of the President and the Department was renamed
Department of Health (DOH). Under this set-up were the following:

1950

Under Executive Order No. 392, s. 1950, the Department of Health gained additional functions
brought about by the transfer of the Institute of Nutrition, together with the Division of Biological
Research and the Division of Food Technology from the Institute of Science, and the Public Schools
Medical and Dental Services from the Office of the President of the Philippines and the Bureau of
Public School respectively to the DOH. Within the Department of Health, certain changes were also
effected thru the transfer of the Division of Health Education and Information from the Bureau of
Health to the Department proper, in exchange for which the drug Inspection Division was
transferred to the former office from the latter; the conversion of the Section of Tuberculosis into a
Division of Tuberculosis, directly under the Office of the Secretary, and the conversion of the Division
of Laboratories into an Office of Public Health Research Laboratory.

1958
The creation of eight regional health offices and two Undersecretaries of Health: the Undersecretary
of health and the Medical Services and the Undersecretary of Special Services.
1971 The creation of the Food and Drug Administration, Bureau of Disease Intelligence Center,
Malaria Eradication Service, Bureau of Dental Health Service, the National Comprehensive Maternal
and Child Health / Family Planning Program, National Nutrition Program, and the National
Schistosomiasis Control Commission, among others.

1972

Through Letter of Implementation No. 8, pursuant to Presidential Decree No.1, Sept.24, 1972, the
DOH was renamed Ministry of Health. The National Cancer Center and Radiation Health Service were
created. The Ministry was divided into 12 regions covering several provinces and cities under a
regional health director. Attached offices were the Philippine Medical Care Commission, the
Dangerous Drugs Board, National Nutrition Council, Population Commission, National
Schistosomiasis Control Council and the Tondo General Hospital.

1982

Under Executive Order No. 851, the Health Education and Manpower Development Service was
created, and the Bureau of Food and Drugs assumed the functions of the Food and Drug
Administration.

1986

The Ministry of Health became Department of Health again.

1987
Another re-organization under Executive Order No. 119, which placed under the Secretary of Health
five offices headed by an undersecretary and an assistant secretary. These offices are the Chief of
Staff, Public Health Services, Hospital and Facilities Services, Standard and Regulations, and
Management Service.
1992

Full implementation of Republic Act No. 7160 or Local Government Code. The DOH changed its role
from one of implementation to one of governance. Significant change: branching out of the Office of
the Public Health Services to form the Office for Special Concerns. Two big offices merged to become
the Office of Hospital Facilities, Standards and Regulation. Special projects were highlighted like the
NID. National Micronutrient Campaign, Disaster Management, Urban Health and Nutrition Project,
Traditional Medicine, Doctors to the Barrios Program, "Let’s DOH It"! became a national battlecry.

1999

The functions and operations of the DOH was directed to become consistent with the provisions of
Administrative Code 1987 and RA 7160 through Executive Order 102. The Health Sector Reform
Agenda of the Philippines, 1999-2004 was launched. The reforms are: provide fiscal autonomy to
government hospitals; secure funding for priority health programs; promote the development of
local health systems and ensure its effective performance; strengthen the capacities of health
regulatory agencies and expand coverage of the National Health Insurance Programs. National
Objectives for Health 1999-2004 was launched. This states the Philippines objectives for the
eradication and control of infectious diseases commonly affecting our people, major chronic
illnesses and injuries that compromise lives of the productive sector. It encourages promotion of
healthy lifestyle and health-seeking behaviors to prevent or control certain debilitating illness and
life-threatening diseases

2000

The year 2000 marked the institutionalization of the Health Sector Reform Agenda (HSRA). The
HSRA was endorsed for approval and support by the National Government Agencies, national and
local stakeholders in health, and partners in the international community. The HSRA has become the
major framework for policies and investments for the health sector .

2001

In July 13, 2001, Administrative Order 37 which contained the guidelines on the operationalization of
the HSRA implementation plan was signed by Sec. Manuel Dayrit. It is also during this year that the
13 convergence sites or the advance implementation areas have been established.

2003

The One-Script Systems Improvement Program was established (AO 50. S. 2003) to orchestrate
unity, synchronicity and focused targeting of priority public health programs that would provide the
biggest impact to attaining equity, efficiency, access and quality health care in the country. A major
breakthrough was achieved in providing fiscal autonomy to 68 DOH retained hospitals with the
approval of a special provision of FY 2003 GAA which authorized 100% retention and the use of
hospital income for upgrading of health facilities and services.

2005

FOURmula ONE for Health (F1) was launched as the health sectors blue print for the implementation
of reforms to bring about better health outcomes, more responsive health system and more
equitable healthcare financing. Province-wide Investment Plans for Health were developed in 16
provinces as the basis of F1 implementation in these sites.

2006

The Presidential Anti-Graft Commission recognized and awarded the DOH as the number one
government agency in fighting corruption. DOH also topped in the Pulse Asia 3rd Quarter Survey as
the number one government agency in terms of overall performance.

3. LOCAL HEALTH SYSTEM AND DEVOLUTION OF EALTH SERVICES

LOCAL HEALTH SYSTEMS

The implementation of the Local Government Code of 1991 resulted in the devolution of health
services to local government units (LGUs) which included among others the provision, management
and maintenance of health services at different levels of LGUs. What used to be a centralized
national health system became many independent local health systems. After more than seventeen
(17) years of devolution, improvements in health status of populations show marked variations
across LGUs. Variations in health status were associated with variations in the performance of health
care providers and health care professionals in localities. In spite of the devolution, the DOH is still
the institutional steward of the nation’s health system. As the prime national health agency, it has
the authority to provide coherence and direction in enhancing operational effectiveness of local
health systems towards improved health status in localities. The DOH encouraged provinces and
their component municipalities and cities to plan together and develop a five (5) year Provincewide
Investment Plan for Health (PIPH). This medium-term health plan became the key instrument that
DOH utilized to forge partnership with the LGUs towards improved health outcomes, more equitable
financing of health care and greater public satisfaction. As an approach to health reforms, the PIPH
represents all the stakeholders’ interests since all LGU officials and health stakeholders plan
together to improve the health system of the province. As of 2010, 80 provinces and 8 cities have
completed their five (5) year investment plans for health (PIPH/CIPH) including their annual
operational plans (AOP) (Department of Health, 1980-2010). These Plans undergo a review by a Joint
Appraisal Committee (JAC) prior to DOH approval. The signing of a Memorandum of Agreement
(MOA) between DOH and the LGU to support local health reform implementation triggers a series of
inter-related events to facilitate the annual operationalization of the PIPH/CIPH: (1) release of start-
up funds to jumpstart plan implementation ; (2) review and approval of the AOP; (3) forging of an
annual DOH-LGU Service Level Agreement (SLA) which details DOH and health partner commitments
as contained in the AOP ; (4) release of the DOH annual fixed allocation and other support; and (5)
release of a performance-based incentive for the previous year achievement of specific indicators
from the Local Government Unit (LGU) Scorecard. The LGU Scorecard is the tool institutionalized by
the DOH to track and assess the overall outcome of implementing health reforms in the province-
wide health system (PWHS). It measures intermediate Page | 111 outcomes of access, quality and
efficiency including major reform outputs based on the Programs, Projects and Activities (PPAs) of
the DOH. The LGU Scorecard thus provides a composite performance assessment of the efforts of
various stakeholders within the PWHS. Over time, a reformed PWHS will progressively achieve the
national targets for the intermediate outcome indicators and show all excellent rating (greens) in the
LGU Scorecard. It will ultimately exhibit no performance disparity across all its component
municipalities/cities and inter-local health zones (ILHZs). The goal for 2016 is to reduce the disparity
of performance, particularly for the poor, among local health systems (LHS). Local health
development will be supported by building systems for evidence-based policies, decision making and
accountability mechanisms to strengthen local health authority, expand their partner and support
networks, and improve client-centered care and community participation adopting Primary Health
Care (PHC) principles in the context of Universal Health Care.

4.CLASSIFICATION OF HEALTH FACILITIES (DOH AO-0012A)

Health Secretary Enrique T. Ona today declared that the new guidelines on the classification of
hospitals and other health facilities will result to improved health services for the people.

Under the Department of Health’s (DOH) Administrative Order 2012-0012, signed last July 18, 2012,
a health facility must have, among others, an operating room to be considered a Level 1 hospital.
The AO conforms to the mandate of Republic Act No. 4226, the Hospital Licensure Act, which
requires a hospital to have surgical and ancillary services for its operation to be permitted.

The previous DOH guidelines did not require Level 1 hospitals to have an operating room and those
health facilities with functioning operating rooms were considered Level 2 hospitals. Health facilities
previously classified as Level 1 hospitals without operating rooms will now be considered as primary
care facilities.

As of 2011, there were 733 government and 1,088 private hospitals, with 372 government and 399
private Level 1 hospitals under the old classification.

“With the new classification of hospitals and other health facilities, we are ensuring that all our
hospitals have the minimum capacity to render emergency surgical care, such as cesarean sections
and appendectomies,” Ona said.

AO 2012-0012 classifies hospitals in the Philippines based on ownership (government or private),

scope of services (general or specialized), and functional capacity (level 1, 2 or 3).
Among others, a Level 1 hospital must have an operating room to be able to provide surgical
services. A Level 2 hospital has all of Level 1 capacity and must be departmentalized, equipped to be
able to provide services in the specialties of medicine, surgery, pediatrics and obstetrics-gynecology
and has an intensive care unit. A Level 3 hospital has all of Level 2 capacity plus a residency or
teaching program.

Ona also said that the DOH’s Health Facilities Enhancement Program will upgrade government
district hospitals without operating rooms for these facilities to be able to comply with the new
guidelines. As of March 2012, an estimated 137 out of 283 district hospitals classified as Level 1
hospitals in the previous system have no operating rooms. For 2013, P 2.3 billion will be used to
upgrade these district hospitals.

“Patients needing surgical care who are brought to some of our district hospitals often have to be
referred to provincial or regional hospitals. With our new guidelines and with the upgrading of our
district hospitals under the health facilities enhancement program, our patients are assured of
timely surgical care,” Ona concluded.

5. Philippine Health Agenda

President Rodrigo Duterte has recently released the Philippine Health Agenda 2016-2022, which
strengthens the Duterte Health Agenda, “All for Health towards Health for All”. This health system,
through the Department of Health, aspires financial protection, better health outcomes and
responsiveness for all Filipinos.

In order to attain health-related sustainable development goals, the A.C.H.I.E.V.E. strategy

is followed:

A- Advance quality, health promotion and primary care

C- Cover all Filipinos against health-related financial risk

H- Harness the power of strategic HRH development

I- Invest in eHealth and data for decision-making

E- Enforce standards, accountability and transparency

V- Value all clients and patients, especially the poor, marginalized, and vulnerable

E- Elicit multi-sectoral and multi-stakeholder support for health

 With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a health system with the values of
Equity, Quality, Efficiency, Transparency, Accountability, Sustainability, Resilience towards “Lahat
Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat”.

D. Levels of Prevention
There are three levels of prevention:

1. improving the overall health of the population (primary prevention)

2. improving (secondary prevention)
3. improving treatment and recovery (tertiary prevention).

Each of the three approaches has an important role to play in disease prevention. However, upstream
approaches, e.g. primary prevention, generally tend to be cheaper and more efficient, and they entail
lower morbidity and mortality rates. Health promotion (EPHO 4) is inextricably intertwined with disease
prevention.

 Primary prevention: routine immunization programmes are established in some form in all countries,
and in most cases are well developed and effective. However, arrangements for delivery of vaccine
programmes are under-developed in some countries, especially for minority populations. Some
Commonwealth of Independent States have seen an increase in vaccine preventable diseases following
the breakdown of services available in the Soviet era.
 Secondary prevention: routine screening for major forms of cancer now exists in many countries, but not
in all of them. Screening programmes are not always evidence-based and systemic health checks for
noncommunicable diseases are not routine in most countries.
 Tertiary prevention: lack of availability and affordability of treatment for early stage cancers is a limiting
factor in some countries. Staff need training in evidence-based treatment and management approaches
for noncommunicable diseases, and modern equipment.

E. UNIVERSAL HEALTH CARE

1. Legal Basis
The Department of Health (DOH) celebrates the signing of the Universal Health Care (UHC) Act into
law and congratulates all Filipinos for this accomplishment. DOH acknowledges the consistent support
from legislators and different stakeholders from civil society organizations, local government units,
other national government agencies, and international partners in pushing for the UHC Act.

“Health is everybody’s business. Health systems only work when everyone works together to ensure
that no one is left behind,” says Secretary Francisco T. Duque III.

UHC is both a vision and a commitment to the health of all Filipinos by providing the full range of high
quality health care services – from preventive to promotive, curative, rehabilitative, and palliative –
at affordable cost. The signing of the UHC Act is a remarkable achievement as it marks the beginning
of a new chapter in the reform of the Philippine health system. These include operationalizing primary
health care and mainstreaming health promotion to protect people from disease, empowering
individuals and communities to maintain good health, and supporting effective management of illness
and disability. It will shift the health system’s current treatment-oriented approach towards a more
balanced approach emphasizing prevention and health promotion.

Among the significant reforms that will be implemented over time include: automatic enrollment of
all Filipinos to PhilHealth; designating PhilHealth as the national purchaser for health goods and
services for individuals, such as medicines; improvement of health facilities especially in underserved
areas; responding to the gap in health workers throughout the country; strategic engagement of the
private sector; and creating and expanding new functions in DOH to improve the delivery of health
services.

“We thank the commitment of our Senators and Congresspersons to legislating for the people’s
health, and the President’s fulfillment of his promise to improve the healthcare system of the country
for the benefit of all Filipinos. Let us harness this momentum, walang iwanan at sama-sama tayo
tungo sa UHC!” Secretary Duque added. The period for drafting the law’s implementing rules and
regulations immediately follows its signing with public consultations and multi-sectoral dialogues
scheduled in the coming months.

To ensure the implementation of this comprehensive and long-term reform, the Department of Health
is also actively working for higher excise taxes on both tobacco and alcohol, and seeks the support of
all legislators who made UHC possible to also advocate for and support the passage of these twin
landmark health reforms of smart taxes for health.

2. Background and Rationale

Health-related public policies and laws have provided the impetus for comprehensive reform
strategies identified in the Health Sector Reform Agenda (HSRA) launched in 1999 and its
implementation framework, the FOURmula One (F1) for Health in 2005. Since then, substantial gains
in health sector improvements have been achieved in the areas of social health insurance coverage
and benefits, execution of Department of Health (DOH) budgets and its use to leverage local
govemment unit (LGU) performance, LGU spending in health, systematic health investment planning
through the Province-wide Investment Plan for Health (PIPHy Citywide Investment Plan for Health
(CIPHy Annual Operational Plan (AOP) process, capacities of government health facilities, and the
implementation and monitoring of public health programs. However, poor Filipino families have yet
to experience equity and access to critical health services, despite all of these achievements. DOH
and PhilHealth recently conducted a joint Benefit Delivery Review highlighting the need to increase
enrollment coverage, improve availment of benefits and increase support value for claims in order
for the National Health Insurance Program (NHIP) to provide Filipinos substantial f,rnancial risk
protection. More importantly, benefit delivery for the sponsored program (poorest quintile) was
found to be lowest among our people. To date, only 53 percent of the entire population is covered
by the program, wrth 42 percent availment rate, and 34 percent support value or a total benefit
delivery ratio of 8 percent. Public hospitals and health facilities have also suffered neglect due to the
inadequacy of health budgets in terms of support for upgrading to expand capacity and improve
quality of services. As of October 2010, eight hundred ninety two (892) rural health units (RHUs) and
ninety nine (99) govemment hospitals have yet to qualify for accreditation by PhilHealth. Data have
also shown that the poorest of the population are the main users of govemment health facilities.
This means that the deterioration and poor quality of many government health facilities is
particularly disadvantageous to the poor who needs the services the most. Moreover, weaknesses in
management and compensation of human resources for health have not been adequately addressed
and inadequacies in health information systems to guide planning and implementation of health
programs also need urgent attention. Lastly, while the Philippines is on target for most of its
Millennium Development Goals (MDG), it is lagging behind in reducing maternal and infant
mortality. These two indicators are still at 162 per i00,000 live births and 25 per 1,000 live births
respectively (2005 FPS and 2008 NDHS), with 2015 MDG targets at 52 and 19, respectively. There is
also wide difference in outcomes and program performance in these priority public health programs
across geographic areas and income groups that particularly affect the poor. To address these
challenges, the Aquino Health Agenda (AHA) is being launched to improve, streamline and scale up
reform interventions espoused in the HSRA and implemented under Fl. This deliberate focus on the
poor will ensure that as the implementation of health reforms moves forward, nobody are left
behind. To successfully implement the Aquino Health Agenda, the Philippine health system will
require the following components: enlightened leadership and good governance practices; accurate
and timely information and feedback on performance; financing that lessens the impact of
expenditures especially among the poorest and the marginalized sector; competent workforce;
accessible and effective medical products and technologies; and appropriately delivered essential
services. This Order provides the objectives, strategic thrusts, and implementation framework to
implement the Universal Health Care (UHC)

3.Objective and thrust

Universal Health Care and Its Aim

Universal Health Care (UHC), also referred to as Kalusugan Pangkalahatan (KP), is the “provision to
every Filipino of the highest possible quality of health care that is accessible, efficient, equitably
distributed, adequately funded, fairly financed, and appropriately used by an informed and
empowered public”.1 The Aquino administration puts it as the availability and accessibility of health
services and necessities for all Filipinos.

It is a government mandate aiming to ensure that every Filipino shall receive affordable and quality
health benefits.This involves providing adequate resources – health human resources, health
facilities, and health financing.

UHC’s Three Thrusts

To attain UHC, three strategic thrusts are to be pursued, namely: 1) Financial risk protection through
expansion in enrollment and benefit delivery of the National Health Insurance Program (NHIP); 2)
Improved access to quality hospitals and health care facilities; and 3) Attainment of health-related
Millennium Development Goals (MDGs).

Financial Risk Protection

Protection from the financial impacts of health care is attained by making any Filipino eligible to
enroll, to know their entitlements and responsibilities, to avail of health services, and to be
reimbursed by PhilHealth with regard to health care expenditures.

PhilHealth operations are to be redirected towards enhancing national and regional health insurance
system. The NHIP enrollment shall be rapidly expanded to improve population coverage. The
availment of outpatient and inpatient services shall be intensively promoted. Moreover, the use of
information technology shall be maximized to speed up PhilHealth claims processing.

Improved Access to Quality Hospitals and Health Care Facilities

Improved access to quality hospitals and health facilities shall be achieved in a number of creative
approaches. First, the quality of government-owned and operated hospitals and health facilities is to
be upgraded to accommodate larger capacity, to attend to all types of emergencies, and to handle
non-communicable diseases. The Health Facility Enhancement Program (HFEP) shall provide funds to
improve facility preparedness for trauma and other emergencies. The aim of HFEP was to upgrade
20% of DOH-retained hospitals, 46% of provincial hospitals, 46% of district hospitals, and 51% of
rural health units (RHUs) by end of 2011.

Financial efforts shall be provided to allow immediate rehabilitation and construction of critical
health facilities. In addition to that, treatment packs for hypertension and diabetes shall be obtained
and distributed to RHUs.
The DOH licensure and PhilHealth accreditation for hospitals and health facilities shall be
streamlined and unified.

Attainment of Health-related MDGs

Further efforts and additional resources are to be applied on public health programs to reduce
maternal and child mortality, morbidity and mortality from Tuberculosis and Malaria, and incidence
of HIV/AIDS. Localities shall be prepared for the emerging disease trends, as well as the prevention
and control of non-communicable diseases.

The organization of Community Health Teams (CHTs) in each priority population area is one way to
achieve health-related MDGs. CHTs are groups of volunteers, who will assist families with their
health needs, provide health information, and facilitate communication with other health providers.
RNheals nurses will be trained to become trainers and supervisors to coordinate with community-
level workers and CHTs. By the end of 2011, it is targeted that there will be 20,000 CHTs and 10,000
RNheals.

Another effort will be the provision of necessary services using the life cycle approach. These
services include family planning, ante-natal care, delivery in health facilities, newborn care, and the
Garantisadong Pambata package.

Better coordination among government agencies, such as DOH, DepEd, DSWD, and DILG, would also
be essential for the achievement of these MDGs.