Levels of Health

Facilities
Restructured Health
Care Delivery System
Objectives:

At the end of discussion, the class will be able to:

 Understand the Philippine Health Care Delivery
System.
 Identity the three levels of health facilities
Introduction

A Public Health Nurse does not function in a

vacuum. She is a member of a team working within
a system. In order for the nurse to function
effectively she has to understand the health care
delivery system wherein she is working because it
influences her status and functions. She needs to
properly relate with the dynamics of the political,
organizational structure surrounding her position in
the health care delivery system.
Philippine Health Care Delivery System

Is composed of two sectors:

 The public sector
 The private sector
The Public Sector
 Consists of national and local agencies providing
health services
 National: Department of Health
 Local:
❑Local Government Units (LGUs)
❑The provincial and district hospitals
❑health centers/rural health units
❑barangay health stations.
The Private Sector
 clinics and hospitals,
 health insurance,
 manufacturers of medicines,
 vaccines,
 medical supplies,
 equipment and other health and nutrition
products,
 research and development,
 human resource development
 other health-related services
 Philippine Department of Health

 Historical Background
 Pre-spanish and Spanish Periods (before 1989)
❑Traditional health care practices
❑In 1876, Medicos Titulares were already
existing.
❑In 1888, Superior Board of Health and Charity
 June 23, 1989
Department of Public Works,
Education and Hygiene was created by
virtue of a decree signed by President
Emilio Aguinaldo.
 September 29, 1898
General Orders No. 15 established
the Board of health for the City of
Manila
 July 1, 1901
❑Act no. 157 – Board of Health for the Philippine Islands
❑Acts No. 307 & 308 – Provincial and Municipal Boards
 October 26, 1905
Insular Board of health was replaced by the bureau of
health.
 1912
❑Act No. 2156 (Fajardo Act) – into sanitary divisions;
Health fund for travel and salaries
 1915
❑Act No. 2468 – from Bureau of Health into Philippine
Health Service
❑“Semi-military system of public health
administration”
 August 2, 1916
❑ The passage of Jones Law also known as Philippine
Autonomy Act.
❑Administration Code of 1917 (Act 2711), which
included the Public health law
 1932
Act No. 4007 known as the Reorganization Act of
1932, reverted back the Philippine Service into the
Bureau of Health,
 May 31, 1939
❑Commonwealth Act No. 430 – Department of Public
Health and Welfare but was only completed through
Executive Order No. 317
❑Dr. Jose Fabella became first secretary in 1941
 1942
During the period of the Japanese occupation,
various reorganizations and issuances for the health
and welfare of the people were instituted and
lasted until the Americans came in 1945 and
liberated the Philippines.
 October 4, 1947
❑Executive order No. 94 provided for the post
war reorganization of the Department of Health
and Public Welfare, resulted in the split of
Department of Public Welfare which became
Social Welfare Administration) and Philippine
General Hospital to the Office of the President
❑another split between curative (Bureau of
Hospitals) & preventive services (Bureau of
Health)
❑Nursing Service Division was also established
 January 1, 1951
 conversion of Sanitary District to Rural Health
Unit, carrying the ff. services:
❑maternal & child health,
❑environmental health,
❑communicable disease control,
❑ vital statistics,
❑medical care,
❑health education,
❑public health nursing
 resulted in passage of Rural Health Act of 1954
(RA1082)
 1970
❑Restructured Health Care Delivery System
(primary, secondary, & tertiary)
❑Public Health Nurse to population ratio was
1:20,000
 June 2, 1978
❑PresidentialDecree 1397 renamed
the DOH to Ministry of Health
during the Martial Law Declaration
❑Secretary Gatmaitan became the
first Ministry of Health
 December 2, 1982
E.O. 851 reorganized Ministry of Health as an
integrated health care delivery system through the
creation of Integrated Provincial Health Office,
combining the public health and hospital operations
under the PHOs
 April 13, 1987
E.O. no. 119: transformed MOH
back to the name Department of
Health by President Corazon Aquino
 October 10, 1991
RA 7160 known as the Local Government Code
 May 24, 1999
E.O. 102 “Redirecting the Functions & Operations
of the DOH” by President Joseph Estrada
 1999-2004
Development of the Health Sector Reform Agenda
which describes the major strategies, organizational
and policy changes and public investments needed
to improve the way health care is delivered,
regulated and financed.
 2005 to present
Development of a plan to rationalize the
bureaucracy in an attempt to scale down including
the DOH
 The Department Of Health
ROLES AND FUNCTIONS
✓ Leadership in Health
 Serve as the national policy & regulatory
institution
 formulation, monitoring and evaluation of
national health policies, plans and programs
 Serve as advocate in the adoption of health
policies, plans, and programs
ROLES AND FUNCTIONS
✓ Enabler and Capacity Builder
 innovate new strategies in health
 monitoring & evaluation of national health
policies, plans & programs
 ensure highest achievable standards of quality
health care, health promotion & health protection
ROLES AND FUNCTIONS
✓ Administrator of Specific Services
 manage selected national & sub-national health
facilities & hospitals w/ modern facilities that
shall serve as referral centers
 administer direct services for emerging health
concerns
 emergency response services, including referral
and networking system
 VISION
The DOH is the leader, staunch advocate and
model in promoting health for all in the Philippines.
 MISSION
Guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor and shall
lead the quest for excellence in health.
GOAL: Health Sector Reform Agenda
(HSRA)
Rationale for Health Sector Reform
 For the last 50 yrs, the ff conditions are still seen among the pop’n:
✓slowing down in reduction of IMR & MMR
✓persistencein large variations in health status across population
groups & geographic areas
✓High burden from infectious diseases
✓Rising burden of chronic & degenerative diseases
✓Unattended emerging health risks from environmental & work
related factors
✓Burden of disease is heaviest in poor
Reasons why the conditions are still seen:

 Inappropriate health delivery system

 Inadequate regulatory mechanism
 Poor health care financing and inefficient sourcing
or generation of funds for healthcare
 Framework for Implementation of
HSRA:
 FOURmula ONE for
Health
 Goals of FOURmula  4 elements of strategy
ONE for Health
✓ Health financing
1. Better health
✓ Health regulation
outcomes
✓ Health service
2. More responsive
delivery
health systems
✓ Good governance
3. EQUITABLE health
care financing
 Local Health System
Objectives:
 Establish local health systems for effective & efficient delivery
of health care services
 Upgrade health care management & service capabilities of local
health facilities
 Promote inter-LGU linkages & cost sharing schemes including
local health care financing systems for better utilization of local
health resources
 Foster participation of the private sector, NGOs & communities
in local health systems development.
 Ensure the quality of health service delivery at the local level
 Inter Local Health System
 Espoused by DOH to ensure quality HC at local level
 It is a system of health care similar to a district health
system
 clustering municipalities into Inter Local Health Zone
(ILHZ).
 Each ILHZ has a defined population within a defined
geographical area and comprises a central referral hospital
and a number of primary level facilities such as Rural
Health Units and Barangay Health Station.
 Expected Achievement of the Inter-local
Health System:
1. Universal coverage of health
insurance
2. Improved quality of hospital
& RHU service
3. Effective referral system
4. Integrated planning
5. Appropriate health
information system
6. Improved drug management
7. Developed human resources
8. Effective leadership through inter-
LGU corporation
9. Financially visible or self-sustaining
hospitals
10. Integration of public health &
curative hospital care
11. Strengthened cooperation between
LGU & health sectors
 Guiding Principles
1. Financial & Administrative autonomy of the
provincial & municipal administrations
2. Strong political support
3. Strategic synergies & partnerships
4. Community participation
5. Equity of access to health services by the
population, especially the poor
6. Affordability of health services
7. Appropriateness of health programs
8. Decentralized management
9. Sustainability of health initiatives
10. Upholding of standards of quality health service
Composition of the Inter-Local Health Zone
1. People
2. Boundaries
3. Health Facilities
4. Health Workers
 Primary Health Care as an approach to
Delivery of Health Care Services

 Focuses responsibility for health on the individual,

his family and the community.
 Includes the full participation and active
involvement of the community towards the
development of self-reliant people, capable of
achieving an acceptance level of health and well-
being.
 Elements/Components of Primary
Health Care
 Environmental Sanitation
 Control of Communicable Diseases
 Immunization
 Health Education
 Maternal and Child Health and Family Planning
 Adequate Food and Proper Nutrition
 Provision of Medical Care and Emergency Treatment
 Treatment of Locally Endemic Diseases
 Provision of Essential Drugs
Strategies
 Reorientation and reorganization of the national health care system
 Effective preparation and enabling process for health action at all
levels
 Mobilization of the people Development and utilization of
appropriate technology
 Organization of communities
 Increase opportunities for community participation
 Development of intra-sectoral linkages with other government and
private agencies
 Emphasizing partnership
 Four Cornerstones/Pillars in Primary
Health Care
 Active Community Participation
 Intra and Inter-sectoral linkages
 Use of appropriate technology
 Support mechanism made available
Levels of Health Care and Referral System

Primary Level of Care

 Devolved in the cities and the municipalities
 Health care provided by center physicians, public
health nurses, rural health midwives, barangay
health workers, traditional healers
 Usually the first contact between the community
and the other levels of health facility
Secondary Level of Care
 Given by physicians with basic health training
 Given in health facilities either privately owned
or government operated
 Referral center for the primary health facilities
Tertiary Level of Care
 Rendered by specialists in health facilities
including medical centers as well as regional and
provincial hospitals, and specialized hospitals
 Referral center for secondary care facilities
 Complicated cases and intensive care