THE HEALTH CARE

DELIVERY SYSTEM
Lesson Content
● World Health Organization
● Sustainable Development Goal
● Philippine Development of Health
● Historical Background
● Local Health System and Devolution of Health Service
● Philippine Health Agenda 2010- 2022
● Millenium Development Goals
● Primary Health Care
● Department of Health
● Levels of Prevention
● Universal Health Care
Objectives/Competencies:
Upon completion of this module you are expected to:

1. Discuss how the World Health Organization (WHO) affects health issues in the Philippines
2. Explain the Millennium Development Goals (MDG’s) and the targets of the health related
MDG’s
3. Enumerate the Key Principles of Primary Health Care.
4. Relate the application of the PHC key principles in the implementation of Public health
programs
5. Explain how the Department of Health provides health leadership in the Philippines.
6. Relate the strategic thrusts of Universal Health Care to the current health situation and the
goals and objectives of Universal Health Care
 World Health Organization
When diplomats formed the UN in 1945, they also discuss the creation of a
global health organization. The World Health Organization (WHO) who was
the outcome of this discussions. The WHO constitution came into force on
April 7, 1948.Since then, April 7 has been celebrated each year as World
Health Day (WHO,2013a). With its headquarters in Geneva, Switzerland,
WHO has 147 country offices and 6 world regional offices for Africa, the
Americas, Eastern Mediterranean, Europe, Southeast Asia and the Western
Pacific The Philippines is a member of the Western Pacific Region, which
holds office in Manila (WHO,2007b).
 World Health Organization
Core Functions:

● Providing leadership on matters critical to health and engaging in partnerships where

joint action is needed. WHO has 193 member countries and 2 associate members.
WHO and its members work with UN agencies, NGO’s and the private sector (WHO,
2006). The WHO Country Focus is directed toward providing technical collaboration
with member states in accordance with each country needs and capacities
(WHO,2013c).
● Shaping the research agenda and stimulating the generation, translation and
disseminating valuable knowledge. The WHO strategy on Research for Health has
five Goals (WHO,2013g).
 World Health Organization
Five Goals:
1. Capacity in reference to capacity building to strengthen national health research
systems
2. Priorities to focus research on priority health needs particularly in low - and
middle-income countries.
3. Standards to promote good research practice and enable the greater sharing of
research evidence, tools and materials.
4. Translation to ensure that quality evidence is turned into products and policy.
5. Organization to strengthen the research culture within WHO and improve the
management and coordination of WHO research activities.
WORLD HEALTH ORGANIZATION
1. Sustainable Development Goals – The Sustainable
Development Goals (SDGs), otherwise known as the Global
Goals, are a universal call to action to end poverty, protect the
planet and ensure that all people enjoy peace and prosperity.
WORLD HEALTH ORGANIZATION
2. The 2030 Agenda for Sustainable Development, adopted by all United
Nations Member States in 2015,provides a shared blueprint for peace
and prosperity for people and the plan et, now and into the future. At its
heart are the 17 Sustainable Development Goals (SDGs), which are an
urgent call for action by all countries - developed and developing - in a
global partnership. They recognize that ending poverty and other
deprivations must go hand-in-hand with strategies that improve health
and education, reduce inequality, and spur economic growth – all while
tackling climate change and working to preserve our oceans and forests.
THE 17 SDGs TO TRANSFORM OUR
WORLD
THE 17 SDGs TO TRANSFORM OUR
WORLD
THE 17 SDGs TO TRANSFORM OUR
WORLD
THE 17 SDGs TO TRANSFORM OUR
WORLD
4.QUALITY EDUCATION
THE 17 SDGs TO TRANSFORM OUR
WORLD
5.GENDER EQUALITY
THE 17 SDGs TO TRANSFORM OUR
WORLD
6.CLEAR WATER AND SANITATION
THE 17 SDGs TO TRANSFORM OUR
WORLD
THE 17 SDGs TO TRANSFORM OUR
WORLD
THE 17 SDGs TO TRANSFORM OUR
WORLD
THE 17 SDGs TO TRANSFORM OUR
WORLD
THE 17 SDGs TO TRANSFORM OUR
WORLD
PHILIPPINE DEVELOPMENT OF
HEALTH
Mission-Vision
A global leader for attaining better health outcomes,
competitive and responsive health care system, and
equitable health financing. To guarantee equitable,
sustainable and quality health for all Filipinos, especially
the poor, and to lead the quest for excellence in health.
Historical Background
1898 – 1901
❏ Americans assembled a military Board of Health on September 10,
1898, with its formal organization on September 29.
❏ Upon its creation, Dr. Frank S. Bourns is assigned as president while
Dr. C. L. Mullins is assigned as assistant surgeon.
❏ The purpose of this Board of Health was to care for injured American
troops but as the hostilities between Filipinos and Americans waned in
1901, a civilian Board of Health was now deemed appropriate with
Dr. L. M. Maus as the first health commissioner.
Historical Background
1900s
❏ In the early 1900s, 200,222 lives including 66,000 children were
lost; three percent of the population was decimated in the worst
epidemic in Philippine health history.
1901
❏ the Americans organized and erected several institutions,
including the Bureau of Governmental Laboratories, which was
built in 1901 for medical research and vaccine production.
 Historical Background
1905
❏ The Americans, led by Dean Worcester built the UP College of Medicine
and Surgery in 1905, with Johns Hopkins University serving as a
blueprint, at the time, one of the best medical schools in the world.
1909
❏ Nursing instruction was also begun at the Philippine Normal School. In
terms of public health, the Americans improved on the sewer system and
provided a safer water supply.
 Historical Background
1915
❏ The Bureau of Health was reorganized and renamed into the Philippine
Health Service. During the succeeding years leadership and a number of
health institutions were already being given to Filipinos, in accordance
with the Organic Act of 1916.
1919
❏ On January 1, 1919, Dr. Vicente De Jesus became the first Filipino to
head the Health portfolio.
Historical Background

1933
❏ After a reorganization, the Philippine Health Service
reverted to being known as the Bureau of Health.
❏ The official journal pursued, The Health Messenger
and established Community Health and Social
Centers, precursors to today's Barangay Health
Centers.
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Historical Background

1940s
❏ In the 1940s, the Bureau of Health was reorganized
into the Department of Health and Public Welfare, still
under Fabella.
❏ During this time, the major priorities of the agency were
, , , ,
gastrointestinal disease, and the high infant
.
Historical Background

❏ When the Japanese occupied the Philippines,

they dissolved the National Government and
replaced it with the Central Administrative
Organization of the Japanese Army.
❏ Health was delegated to the Department of
Education Health and Public Welfare under
Commissioner Claro M. Recto.
 Historical Background
1944
❏ President Manuel Roxas signed Executive Order (E.O.) No. 94 into
law, calling for the creation of the Department of Health. Dr. Antonio
C. Villarama as appointed Secretary.
1948
❏ A new Bureau of Hospitals and a Bureau of Quarantine was created
under DOH. Under E.O. 94, the Institute of Nutrition was created to
coordinate various nutrition activities of the different agencies.
Historical Background

1958
❏ On February 20, 1958, Executive Order 288 provided
for the reorganization of the Department of Health. This
entailed a partial decentralization of powers and
created eight Regional Health Offices. Under this
setup, the Secretary of Health passed on some of
responsibilities to the regional offices and directors.
 Historical Background
Marcos Administration
❏ The Philippine Heart Center was established on February 14, 1975 with Dr.
Avelino Aventura as director.
❏ With a shift to a parliamentary form of government, the Department of Health was
transformed into the Ministry of Health on June 2, 1978 with Dr. Clemente S.
Gatmaitan as the first health minister.
❏ 1979 – the Philippine Children’s Medical Center was built.
❏ 1983 – the National Kidney and Transplant Institute was set up. This was soon
followed by the Lung Center of the Philippines, which was constructed under the
guidance of Health Minister Dr. Enrique Garcia.
 Local Health System and Devolution of Health
Services
❏ 1991 – the Philippines Government introduced a major devolution of
national government services, which included the first wave of health
sector reform, through the introduction of the Local Government Code
of 1991.
❏ 1992 – The Code devolved basic services for agriculture extension,
forest management, health services, barangay (township) roads and
social welfare to Local Government Units. The Philippines
Government devolved the management and delivery of health
services from the National Department of Health to locally elected
provincial, city and municipal governments.
 Local Health System and Devolution of Health
Services
❏ 1992 – 1997. The result of the study following to the introduction of
devolution, quality and coverage of health services declined in some
locations, particularly in rural and remote areas. It was found that in
system effects included a breakdown in management systems between
levels of government, declining utilization particularly in the hospital
sector, poor staff morale, a decline in maintenance of infrastructure and
under financing of operational costs of services.
Historical Background
2016
❏ Paulyn Jean Ubial announced that in 2017 the government will
start paying the hospital bills and medicines of poor Filipinos.
According to her the DOH is capable of taking care of the
hospital bills and medicines of poor Filipinos. Owing to its bigger
budget in 2017.
❏ Ubial said President Rodrigo Duterte is keen on implementing
the program to help poor Filipinos in all parts of the country. She
said Philhealth will remain a partner of government hospitals in
serving the poor.
❏ q
 Historical Background
❏ Senator Loren Legarda, chair of the Senate committee on finance said that the proposed
❏ 3.35-trillion national budget for 2017 will provide healthcare assistance to all Filipinos,
said an additional
❏ 3 billion was allocated to the Philippine Health Insurance Corporation (PhilHealth) to
ensure coverage for all Filipinos.
❏ “The Department of Health (DOH) said there are some eight million Filipinos still not
covered by PhilHealth. It is our duty, in serving the public, to extend basic healthcare
protection to all our people. That is why we pushed for the augmentation of the
PhilHealth’s budget so that in 2017, we achieve universal healthcare coverage,” she said.
❏ Legarda said universal healthcare coverage means that any non-member of PhilHealth
will automatically be made a member upon availment of healthcare service in a public
hospital
 CONCLUSION OF THE STUDY
❏ The aim of decentralization is to widen decision-making space of
middle level managers, enhance resource allocations from central to
peripheral areas and to improve the efficiency and effectiveness of
health services management.
❏ The findings of the historical review of devolution in the Philippines
reveals some consistencies with the international literature, which
describe some negative effects of decentralization, and provide a
rationale for the Philippines in undertaking a second wave of reform in
order to 'make devolution work'.
❏ New DOH Hospital Classifications 2015
❏ Functions of Hospitals and Development partners in micronutrients
Supplementation.
❏ Creation of inter-agency task force for emerging and re-emerging Infectious
Diseases
❏ Global Influenza Surveillance and Response
❏ Classification of hospital shall be based on Administrative Order No.
2012–0012, dated July 18, 2012, Rules and Regulations Governing the New
Classification of Hospitals and Other Health Facilities in the Philippines" They
shall be classified according to the following:

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 According to Ownership
A. Government
❏ The hospital is created by law.
❏ A government health facility may be under the
National Government, DOH, Local Government Unit
(LGU), Department of Justice (DOJ), State
Universities and Colleges (SUCs),
Government-owned and controlled corporations
(GOCC) and others
 According to Ownership
B. Private
❏ Owned, established, and operated with funds from
donation, principal, investment, or other means by
any individual, corporation, association, or
organization.
According to Scope of Services
A. General Hospital
❏ A hospital that provides services for all kinds of illnesses, diseases, injuries or deformities
❏ It provides medical and surgical care to the sick and injured, maternity, newborn and child
care
❏ It shall be equipped with the service capabilities needed to support board certified/
eligible medical specialists and other licensed physicians rendering services in, but not
limited to the following:
❏ Clinical Services (Family Medicine, Pediatrics, Internal Medicine, Obstetrics and
Gynecology, Surgery)
❏ Emergency Services
❏ Outpatient Services
❏ Ancillary and Support Services (Clinical Laboratory, Imaging Facility, Pharmacy)
According to Scope of Services
B. Specialty
❏ Specializes in a particular disease or condition or in one type of
patient
❏ A specialized hospital may be devoted to the treatment of the
following:
❏ Treatment of a particular type of illness or for a particular condition
requiring a range of treatment
❏ Treatment of patients suffering from a particular diseases of a
particular organ or group of organs
❏ Treatment of patients belonging to a group such as children, women,
elderly or others
❏
According to Functional Capacity
Level 1 General Hospital
A level 1 General Hospital shall have as minimum:
1. A staff of qualified, medical, allied medical and administrative personnel
headed by a physician duly licensed by the PRC.
2. Bed space for its authorized bed capacity, in accordance with DOH
Guidelines in the Planning and Design of Hospitals.
Level 1. General Hospital
3. An operating room with standard equipment and provisions for sterilization of equipment
and supplies in accordance with:

❏ DOH Reference Plan in the Planning and Design of an Operating Room or Theater
❏ DOH Guidelines on Cleaning, Disinfection, and Sterilization of Reusable Medical
Devices in Hospital Facilities in the Philippines.

4. A post-operative Recovery Room.

5. Maternity Facilities consisting of Ward(s), Room(s), a Delivery Room, exclusively for

maternity patients and newborns
 Level 1. General Hospital
6. Isolation facilities with proper procedures for the care and control of infection and
communicable diseases as well as for the prevention of cross infection

7. A separate dental section/ clinic

8. Provision for blood donation

9. A DOH-licensed secondary clinical laboratory with the services of a consulting pathologist

10. A DOH licensed Level 1 imaging facility with the services of a consulting radiologist

11.A DOH licensed pharmacy

 Level 2. General Hospital
As minimum, all of Level 1 capacity, including but not limited to:

1. An organized staff of qualified and competent personnel with Chief of Hospital/Medical

Director and appropriate board certified Clinical Department Heads.

2. Departmentalized and equipped with the service capabilities needed to support board
certified/ eligible medical specialties and other licensed physicians rendering services in the
specialties of Medicine, Pediatrics, Obstetrics and Gynecology, Surgery, their subspecialties,
and other ancillary services.

3. Provision for general ICU for critically ill patients

 Level 2. General Hospital
4. Provision for NICU

5. Provision for HRPU

6. Provision for Respiratory Therapy Services

7. A DOH licensed tertiary clinical laboratory

8. A DOH licensed level 2 imaging facility with mobile X-ray inside the
institution and with capability for contrast examinations
Level 3 General Hospital
1. As minimum, all of Level 2, including but not limited to:
2. Teaching and/or Training Hospital with accredited residency training
program for physicians in the four major specialties namely:
A .Medicine
B. Pediatrics
C .Obstetrics and Gynecology
D Surgery
Level 3 General Hospital
3. Provision for physical medicine and rehabilitation unit
4. Provision for ambulatory surgical clinic
5. Provision for dialysis facility
6. Provision for blood bank
7. A DOH licensed level 3 imaging facility with
interventional radiology
Specialty Hospital
1. A hospital that provides a limited range of services
(e.g., orthopedic surgery, ophthalmology, or obstetrics).
2. A hospital in which two thirds of Medicare patients
receive care for just two Diagnosis-Related Groups
(DRGs).
Trauma Hospital
1. The trauma capability of hospitals shall be assessed in accordance
with the guidelines formulated by the Philippine College of Surgeons
2. Trauma Capable Facility is a DOH licensed hospital designated as
a Trauma Center
3. Trauma Receiving Facility is a DOH licensed hospital within the
trauma service area which receives trauma patients for transport to
the point of care or a trauma center
PHILIPPINE HEALTH
AGENDA 2010-2022
 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
2. Uses resources efficiently
3. Transparent & accountable
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:
1. Devolution
2. Use of Generics
3. Milk Code
4. Philhealth (1995)
5. DOH resources to promote local health system development
6. Fiscal autonomy for government hospitals
7. Good Governance Programs (ISO, IMC, PGS)
8. Funding for UHC
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

2. Limited autonomy to choose provider
3. Less than hygienic restrooms, lacking amenities.
4. Privacy and confidentiality taken lightly
5. Poor record-keeping
6. Overcrowding & under-provision of care
ALL FOR HEALTH TOWARDS HEALTH FOR ALL
(Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat)

AMBISYON NATIN 2040 (Duterte’s Administration)

Universal Health Coverage

Investing in People
Strengthen implementation of
Responsible Parenthood and
Protection Against Reproductive Health Act of 2012 (RPRH
Law)
Instability War Against Drug
Additional Funds from PAGCOR
 ATTAIN HEALTH-RELATED SDG TARGETS
Financial Risk Protection | Better Health Outcomes |
Responsiveness

Values: Equity, Quality, Efficiency, Transparency, Accountability, Sustainability,

Resilience
3 Guarantees:
 GUARANTEE 1
ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE
COMMUNICABLE NONCOMMUNICABLE DISEASES OF RAPID
DISEASES DISEASES & URBANIZATION &
● HIV/AIDS MALNUTRITION INDUSTRIALIZATION
● TB ● Cancer ● Injuries
● Malaria ● Diabetes ● Substance abuse
● Diseases for Elimination ● Heart Disease and their ● Mental Illness
● Dengue Risk Factors – obesity, ● Pandemics
● Leptospirosis smoking, diet, sedentary ● Travel Medicine
● Ebola virus lifestyle ● Health consequences of
● Zika virus ● Malnutrition climate change /
disaster
 SERVICES FOR BOTH THE WELL & THE SICK
● Pregnant
● Newborn
● Infant
● Child
● Adolescent
● Adults
● Elderly
● First 1000 days
● Reproductive and sexual health
● Maternal, newborn, and child health
● Exclusive breastfeeding
● Food & micronutrient supplementation
● Immunization
● Adolescent health
● Geriatric Health
● 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
Guarantee when
3: Services Accessing
are financed Services
predominantly by PhilHealth
PHILHEALTH AS THE GATEWAY TO FREE ● 100% of Filipinos are members
AFFORDABLE CARE ● Formal sector premium paid through payroll
● Non-formal sector premium paid through tax
subsidy

SIMPLIFY PHILHEALTH RULES ● No balance billing for the poor/basic

accommodation & Fixed co-payment for
non-basic accommodation

PHILHEALTH AS MAIN REVENUE SOURCE FOR ● Expand benefits to cover comprehensive range
PUBLIC HEALTH CARE PROVIDERS of services
● Contracting networks of providers within SDNs
 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
Advance quality, health promotion and primary care
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
health graduates
I- Invest in eHealth 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
The Millennium Development Goals

On September 6 to 8,2000, world leaders in the UN General Assembly

participated in the Millennium Summit. The result of the Summit was a
resolution entitled United Nations Millennium Declaration (UN,2013). In this
declaration, the world leaders recognized their collective responsibility to
uphold the principles of human dignity, equality and equity and equity at the
global level. To uphold these principles is their duty to all the people of the
world, especially the most vulnerable and, I particular, the children (UN
General Assembly,2000).
The Millennium Development Goals
1. Eliminate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality. Target: Reduce by two thirds, between 1990
and 2015, the under-five mortality rate.
5. Improved maternal health.
Targets:
a. Reduce by three quarters the maternal mortality ratio
b. Achieve universal access to reproductive health
Eight (8) Millennium Development Goals
6. Combat HIV/AIDS, malaria, and other diseases
Targets:
a. Have halted by 2015 and begun to reverse the spread of
HIV/AIDS.
b. Achieve by 2010, universal access to treatment for HIV/AIDS
for all those who need it.
c. Have halted by 2015 and begun to reverse the incidence of
malaria and other major diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
Eight (8) Millennium Development Goals
Primary Health Care
● Is essential health care made universally accessible to individuals and
families in the community by means acceptable to them, through their full
participation and at cost that the community and country can afford at every
stage of development. (WHO)
● 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.
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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
● Improvement in the level of health care of the community
● Favorable population growth structure
● Reduction in the prevalence of preventable, communicable and other
disease.
● Reduction in morbidity and mortality rates especially among infants
and children.
PHC Objectives
● Extension of essential health services with priority given to the
underserved sectors.
● Improvement in basic sanitation
● Development of the capability of the community aimed at self-
reliance.
● Maximizing the contribution of the other sectors for the social and
economic development of the community.
Primary Health Care
Conceptual Framework
A. Health is a fundamental human right
B. Health is both an individual and collective
responsibility
C. Health should be an equal opportunity to all
D. Health is an essential element of socio-economic
development
Focuses of Primary Health Care

Partnership with the community

Equitable distribution of health resources
Organized and appropriate health system infrastructure
Prevention of disease and promotion of health as focus
Linked multisectorally
Emphasis on appropriate technology
Significant Dates:Primary Health Care
● PHC GOAL (in 1978): Health for All by the year 2000
● PHC was declared in Alma- Ata, USSR during the First International
Conference on PHC held on September 6-12, 1978, through the
sponsorship of WHO and UNICEF.
● LEGAL BASIS OF PHC IN THE PHILIPPINES- Letter of Instruction
(LOI) 949 signed in October 19,1979 by former President Ferdinand
E. Marcos
● Underlying Theme of the Philippine implementation of PHC: Health in
the Hands of People by 2020
 Elements/ Components of Primary Health Care
Health Education
Communicable Disease Control
Expanded Program on Immunization
Locally Endemic Disease Treatment
Environmental Sanitation
Maternal and Child Health and Family Planning
Essential Drugs Provision
Nutrition and Adequate Food Provision
Treatment of Emergency Cases and Provision of
Medical Care
PRIMARY HEALTH CARE
Four Pillars
● Active Community Participation
● Intra and Inter-sectoral linkages
● Use of appropriate technology
● Support mechanism made available
PRINCIPLES & STRATEGIES
1. 4 A’s
● Availability- is a question of whether the basic health services
required by the people are offered in the health care facilities or is
provided on a regular and organized manner.
● Accessibility- usually refers to the physical distance of a health
facility or the travel time required for people to get the needed or
desired health services.
● Affordability- is not only in consideration of the individual or
family’s capacity to pay for basic health services.
● Acceptability- means that the health care offered is in
consonance with the prevailing culture and traditions of the
population.
PRINCIPLES & STRATEGIES

● 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.
 PRINCIPLES & STRATEGIES
2. Community Participation
● Community participation is the heart and soul of
primary health care.
PRINCIPLES & STRATEGIES
3. People are the center, object and subject of development.
● 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.
● Any undertaking must also be based on the people’s needs and problems
(PCF, 1990)
● Part of the people’s participation is the partnership between the
community and the agencies found in the community; social mobilization
and decentralization.
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
 PRINCIPLES & STRATEGIES
BARRIERS OF COMMUNITY INVOLVEMENT
❏ Lack of motivation
❏ Attitude
❏ Resistance to change
❏ Dependence on the part of community people
❏ Lack of managerial skills
 PRINCIPLES & STRATEGIES
4. Self-reliance
❏ Through community participation and 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 develop 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.
 PRINCIPLES & STRATEGIES
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.
 PRINCIPLES & STRATEGIES
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.
PRIMARY HEALTH CARE VERSUS PRIMARY CARE:

Dimension Commercialized Primary Health Care

Health Care OR
Primary Care

Focus of Care Sick Sick and well

individuals

Setting for Services Hospital- based Satellite Health Centers

Urban- centered Community Health
Accessible only to a centers
few people Rural based
Accessible to all

People Passive receiver of Active participants of

health care health care
 PRIMARY HEALTH CARE VERSUS PRIMARY CARE:

Structure Health is isolated from Inter and Intra sectoral

other sectors of society linkaging allows health to
be integrated with over-all
socio - economic
development efforts

Process Decision making from top - Decision making from

down down to up
PRIMARY HEALTH CARE VERSUS PRIMARY CARE:

Technology Curative services based on Promotive and preventive

modern medicine and services blend traditional
sophisticated technology medicine with modern
Physician dominated medicine

Appropriate technology for

frontline health care

Outcome Reliance on health People empowerment or

professionals self-reliance
Adapted from the Traditional versus
Primary Health Care approaches to the
Delivery of health care. YapchiongcoA.S.
and Corcega, T.F(2001), Primary health
care:anoverview,Manila:NTTC-HP
DEPARTMENT OF HEALTH
The Department of Health (DOH) is the national agency mandated to lead the health
sector towards assuring quality health care for all Filipinos.
Department of Health Vision and Mission
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
Department of Health Major Roles:
1. Leader in Health
2. Enabler and capacity builder
3. Administrator of specific services
DEPARTMENT OF HEALTH

Functions: Executive Order 102, series of 1999 (LEADERSHIP ROLE)

1. Planning and formulating policies of health programs and services
2. Monitoring and evaluating the implementation of health programs,
projects, research, training and services
3. Advocating for health promotion and healthy lifestyles
4. Serving as a technical authority in disease control and prevention
5. Providing administrative and technical leadership in health care
financing and implementing the National Health Insurance Law
DEPARTMENT OF HEALTH
As administrator of Specific services (Office of the President, 1999)

1. Serve as administrator of selected health facilities at sub national levels that act as a referral
centers for local health systems that is, tertiary and special hospitals, reference laboratories,
training centers, centers for health promotion, center for disease control, control and
prevention and regulatory offices.
2. Provide specific program components for conditions that affect large segments of the
population such as tuberculosis, malaria, schistosomiasis, HIV/AIDS and micronutrient
deficiencies.
3. Develop strategies for responding to emerging health needs.
4. Provide leadership in health emergency preparedness and response services including
referral and networking systems for trauma, injuries and catastrophic events.
DEPARTMENT OF HEALTH
DOH CORE VALUES:
1. Integrity
2. Excellence
3. Compassion and respect for human dignity
4. Commitment
5. Professionalism
6. Teamwork
7. Stewardship of the health of the people.
DEPARTMENT OF HEALTH
Department of Health is spearheading two programs to ensure equitable
distribution of manpower to the rural areas.
PROGRAMS:
1. Doctor To The Barrios (DTTB) Program
The Doctor To The Barrios Program is the deployment of doctors to municipalities
that are without doctors. DBBT volunteers are fielded to manage the Rural Health
Unit or Health Centers is unserved, economically depressed fifth or sixth class
municipalities for 2 years; they also have the option of being permanently absorbed
by the municipality. These volunteers are offered competitive compensation by the
DOH and the Local Government Unit.
DEPARTMENT OF HEALTH
2. Registered Nurses Health Enhancement and Local Service (RN HEALS)

The RN HEALS is a training and deployment program for unemployed nurses. RN

HEALS volunteers are deployed to unserved, economically depressed
municipalities for one year to address the inadequate nursing workforce in rural
communities and health facilities. It also provides the nurses valuable training to
enhance both their clinical and preventive management competencies.
Compensation for the volunteer nurses are also shared by the DOH and LGU’s.
DEPARTMENT OF HEALTH
Traditional and alternative Health care:

R. A 8423 or the Traditional and Alternative Medicine Act of 1997 was

signed into law through the efforts of then Secretary Juan Flavier. This created the
Philippine Institute and Alternative Health Care which is tasked to promote and
advocate the use of traditional and alternative health care modalities through
scientific research and product development.

Traditional Medicine (R.A.8423) – sum or total of knowledge, skills and

practice on health care not necessarily explicable in the context of modern,
scientific philosophical framework.
The 10 Medicinal Plants endorsed by the Department of Health
Medicinal Plants Use/ Indication Preparation

Asthma, cough and colds, fever, Decoction

dysentery, pain, skin diseases
1. Lagundi Wash affected site with
(scabies, ulcer, eczema),
decoction
wounds

Headache, Stomach ache, Decoction, Infusion

2. Yerba buena cough and colds Rheumatism,
Massage sap
arthritis

3. Sambong Anti edema/ anti urolithiasis Decoction

4. Sambong Anti edema/ anti urolithiasis Decoction

The 10 Medicinal Plants endorsed by the Department of Health
Medicinal Plants Use/ Indication Preparation

5. Niyog- niyogan Anthelmintic Seeds are used

Washing wounds Decoction

6. Bayabas
Diarrhea, gargle, toothache

7. Akapulko Antifungal Poultice

Lowers blood uric acid Decoction

8. Ulasimang Bato (rheumatism and gout)
Eaten raw
The 10 Medicinal Plants endorsed by the Department of Health

Medicinal Plants Use/ Indication Preparation

Hypertension, lowers blood Eaten raw or fried

9. Bawang cholesterol
Apply on part
Toothache

Diabetes Mellitus (mild Decoction

10. Ampalaya non-insulin dependent)
Steamed
Medical Plant Preparations
Preparation Procedure for Preparation

Boil the recommended part of the plant material in

1. Decoction
water. Recommended boiling time is 20 minutes.

Plant material is soaked in hot water, much like

making a tea
2. Infusion
Recommended period of soaking is 10-15 minutes

Directly apply recommended plant material on the

3. Poultice part affected usually used in bruises, wounds or
rashes.

4. Tincture Mix the plant material in alcohol

Levels of Prevention
A. Primary 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.
● Level 1 (Primary Prevention Activities) – Prevention of
problems before they occur.
● Example is Immunization
B. 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.
● Level 2 (Secondary Prevention Activities) – Early detection
and intervention.
● Example is Screening for Sexually transmitted disease
C. 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.
● Level 3 (Tertiary Prevention Activities) – Correction and
prevention of deterioration of a disease state.
● Example is Teaching insulin administration in the home.
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.
UNIVERSAL HEALTH CARE (UHC)
UNIVERSAL HEALTH CARE (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.
UNIVERSAL HEALTH CARE (UHC)
1. Legal Basis
● President Rodrigo Duterte 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.
UNIVERSAL HEALTH CARE (UHC)
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.
UNIVERSAL HEALTH CARE (UHC)
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.