The Philippine Health Care Delivery System and
Primary Health Care as a Strategy
THE HEALTH CARE
DELIVERY SYSTEM OF
THE PHILIPPINES
- An organization of people institution
and resources that deliver the means
of the system.
- The HCDS that we are adopting is
actually based on the template that is
handed to us by the World health
organizations.
- Lack of man-power in some societies
- *Our health care system would impact
to the health of the people but also to
the other components that our people
enjoy and to have.
- The center point or hallmark for the
efforts to combat the pandemic.
- GOAL OF PRIMARY HEALTHCARE: to be
a Self-sustained community
System used by the hospitals to report to the
DOH:
- FHSIS (Field Health Information
System)
- NESSS (National Epidemiologic Sentinel
Surveillance System)
RITM – Research Institute for Tropical
Medicine
A nation’s health care delivery system has a
tremendous impact not only the health of its
people but also on their total development
including their socioeconomic status.
Anderson and Mcfarlene (2011) emphasized
the role of the following factors in shaping
21st century health that further influences
health care delivery system:
1. Health care “reforms” –
governance in healthcare. Refers
to management of resources
and eliminating corruption in
delivering health care resources.
2. Demographics – referring to the
population and its aggregates.
3. Globalization – exposing
ourselves in what’s happening in
the outside world.
4. Poverty and growing disparities
– gap of rich and poor are
getting wider and wider.
5. Social disintegration – refers to
the immergence of a number of
sectors in our society. Result of
kind of progress that we are
experiencing right now.
A Health system consists of all organizations,
peoples, and actions whose primary intent is
to promote, restore, or maintain health. A
health system has six building blocks or
components:
1. Service delivery – ex. Dental
care, Mental health care,
Laboratory and Diagnostic care,
Substance abuse treatment,
Preventative care, Physical and
occupational health, Nutritional
support, Pharmaceutical care,
Transportation, and Prenatal
care.
 2. Health workforce – referring to
personal in charge implementing
the service
3. Information
4. Medical products, vaccines, and
technologies
5. Financing
6. Leadership and governance or
Stewardship –
World Health Organization
- Created to help countries manage their
health programs.
- WHO creates the standard of health
care
 The premier global health organization
is made up of 193 member countries,
the Philippines of which is included.
The core functions of the World
Health Organization are the following:
1. Providing leadership on matters
critical to health and engaging in
partnerships where joint action is
needed.
2. Shaping the research agenda and
stimulating the generation,
translation and disseminating
valuable knowledge. The goals of
research are the following:
 Capacity building
 Focusing on priority
health needs
 Promoting standards for
good research
 Ensure translation of
results to products and
policy
 Organization to
strengthen the research
culture within WHO
3. Setting norms and standards and
promoting and monitoring their
implementation.
4. Articulating ethical and evidence-
based policy options.
5. Providing technical support,
catalyzing change and building
sustainable institutional capacity.
The Millennium Development Goals
 September 6 to 8, 2000 - world leaders
on UN General Assembly participated
in Millennium Summit.
o The result of the summit was a
resolution entitled United
Nations Millennium Declaration.
In this declaration, the world
leaders recognized their
collective responsibility to
uphold the principles of human
dignity, equality and equity at
the global level.
The declaration expressed the
commitment of the 191 member
states, including the Philippines, to
reduce extreme poverty and achieve
seven other targets – now called the
Millennium Development Goals
(MDG’s) by the year 2015.
The following are the eight MDG’s and
the target corresponding to health-
related MDG’s 4,5, and 6:
1. Eradicate extreme poverty and 8. Develop a global partnership for
hunger. development
2. Achieve universal primary
education
3. Promote gender equality and The Philippine Health Care Delivery
empower women System
4. Reduce child mortality.
 Target: reduce by 2/3,
between 1990 and 2015, The Local Government Code of 1991
the under-five mortality
(Republic Act 7160)
rate.
5. Improve maternal health.  Devolves health services to the local
 Target: government unit (LGU). This law
a. Reduce by ¾ the thereby created 2 entities, the
maternal mortality National Government and the Local
ratio Government Units. It likewise pave the
b. Achieve universal way for creating of the Local health
access to boards made up of the City/Municipal
reproductive health Health Boards and the Provincial
6. Combat HIV/AIDS, malaria and Health Boards.
other diseases.
 Target:
a. Have halted by Function of the Local Health Boards
2015 and begun to
1. Propose to Sanggunian the annual
reverse the spread
budgetary allocation
of HIV/AIDS
2. Serves as an advisory committee to
b. Achieve by 2010,
the Sanggunian
universal access to
3. Creates committees that shall
treatment for all
advice local health agencies
those who need it
c. Have halted by
2015, and begun to
The Department of Health
reverse the
incidence of  The Department of Health (DOH)
malaria and other serves as the main governing body of
major diseases. health services in the Philippines. It is a
7. Ensure environmental National Health Agency. It is headed by
sustainability the Secretary of Health who is part of
the Presidential cabinet. It is mandated
 to lead the health sector towards 4. Serving as a technical authority
assuring quality health care for all in disease control and
Filipinos. prevention
5. Providing administrative and
technical leadership in health
DOH Vision care financing and
implementing the National
 To be a Global leader for attaining
Insurance Law
better health outcomes, competitive
6. Enabler and capacity builder
and responsive health care system and
7. Providing logistical support to
equitable health care financing.
the LGU’s
8. Serving as the lead agency in
health and medical research
Major Roles of the Department of
9. Protecting standards of
Health (DOH) excellence in the training and
 Leadership in Health – doh acts as the education of health care
main convener of all health initiatives. providers at all levels of the
(ex. formulating the annual health health care system and
plan, creates policies and guidelines response services.
for implantation of protocols, 10. Administrator of specific
establishes protocols) services
 Enabler / capacity builder – involved in 11. Administrator of selected
training the implementers to health facilities at subnational
implements specific health programs. levels that act as referral
 Administrator – administrates certain centers for local health systems.
health programs especially impact This includes tertiary hospitals,
programs. special hospitals, reference
laboratories, training centers,
health promotion centers for
Specific Functions disease control and prevention
and regulatory offices.
1. Planning and formulating
12. Provide specific program
policies of health programs of
components for conditions that
services.
affect large segment of the
2. Monitoring and evaluating the
population
implementation of health
13. Develop strategies for
programs
responding to emerging health
3. Advocating for health
needs
promotion and health lifestyle
 14. Provide leadership in health - Because of the Local Government
emergency preparedness Code, key health interventions are now
being cascaded to the LGUs through
The DOH core values reflect
their health arm
adherence to the highest standards - The City Health Offices in chartered
of work namely: cities
1. Integrity - Integrated Provincial Health
2. Excellence Office/Rural Health Units in provincial
3. Compassion towns
4. Commitment - LGUs Source of Budget: from the Local
5. Professionalism Government; if charter city – from the
6. Teamwork city gov. / if non-chartered LGU –
7. Stewardship municipal budget with provincial gov.
Main source – Local Government
Intersectoral – partnering with Unit
outside healthcare sectors - To implement their initiative based on
Intrasectoral – partnering with their given situation
inside healthcare sectors

 The DOH carries out its work through Hospitals

the various central bureaus and o General
services in the central offices, Center  Level 1
for Health Development (CHD) in
 Level 2
every region, DOH – attached agencies
 Level 3 (teaching/training)
and DOH – retained hospitals.
o Specialty

The Local Government Unit Other Health Facilities

o Primary care Facility
o Custodial Facility
 The DOH issued administrative order o Diagnostic/Therapeutic Facility
2012-0012 (Rules and Regulations
o Specialized Outpatient Facility
Governing the new Classification of
Hospitals and Other Health Facilities in
the Philippines) that provides for a
new classification scheme of health
facilities.
DOH administrative Order 2012-0012
classifies other health facilities as
follows:
Category A. Primary Health Care Facility – a
first contact health care facility that offers
basic service including emergency services
and provision for normal deliveries.
1. Without in-patient beds like health
centers, out-patient clinics, and dental
clinics.
2. With in-patient beds – a short-stay
facility where the patient spends on the
average of one to two days before
discharge.
Ex. Infirmaries and birthing
(Lying-in) facilites.
Category B. Custodial Care Facility – a health
facility that provides long-term care,
including basic services like food and shelter,
to patients with chronic conditions requiring
ongoing health and nursing care due to
impairment and a reduced degree of
independence in activities of daily living, and
patients in need of rehabilitation.
Ex. Custodial health care
facilities, substance/drug abuse treatment
and rehabilitation centers, sanitaria,
leprosaria, and nursing homes.
Category C. Diagnostic/Therapeutic Facility –
a facility for the examination of the human
body, specimens from the human body for
the diagnosis, sometimes treatment of
disease or water for drinking analysis. The
test covers the preanalytical, analytical and
post analytical phases of examination.
Category D, Specialized outpatient facility –
a facility that performs highly specialized
procedures on an outpatient basis.
Ex: Dialysis clinic, ambulatory surgical
clinic, cancer chemotherapeutic center/clinic,
cancer radiation facility, and physical
medicine and rehabilitation center/clinic.
The Health Referral System
 Referral is a set of activities
undertaken by a health care provider
or facility in response of its inability to
provide the necessary health
intervention to satisfy a patient’s need.
To ensure the continuous care when
doing referral, a system is adopted to
enable the patient to receive seamless
care across the different levels of the
health care delivery system. This is the
two-way referral system.
o A functional referral system is
one that ensures the continuity
and complementation of health
and medical services.
o It usually involves movement of
a patient from the health center
of first contact and the hospital
at first referral level.
o When hospital intervention has
been completed, the patient is
referred back to the health
center. This accounts for the
terms two-way referral system.

Referrals may be internal or external:
 Internal referral – occur within
the health facility; may be
made to request for an opinion
or suggestion, co-
management, or further
management or specialty care.
 External referral – is a
movement of a patient from
one health facility to another.
It may be vertical, where the
patient referral may be from a
lower to a higher level of
health facility or the other way
around.
The Rural Health Unit / City Health
Office
 Commonly known as health center, is a
primary level health facility in the
municipality. The focus of RHU is
preventive and promotive health
services (health promotion and disease
prevention) and the supervision of
BHS’s under its jurisdiction. The
recommended ratio of RHU to
catchment population is 1 RHU =
20,000 population.
 The BHS is the first contact
health care facility that offers
basic services at the barangay
level. It is a satellite station of
the RHU. It is manned by
Volunteer Barangay Health
Workers (BHW’s) under the
supervision of Rural Health
Midwife (RHM)
The Rural Health Unit Personnel
 The Municipal Health Officer (MHO) or
Rural Health Physician heads the
health services at the municipal level
and carries out the following roles and
functions:
1. Administrator of the RHU
a. Prepares the municipal
health plan and budget
b. Monitors the
implementation of basic
health services
c. Management of the RHU
staff
2. Community physician
a. Conducts epidemiological
studies
b. Formulates health
education campaigns on
disease prevention
c. Prepares and implements
control measures or
rehabilitation plan
3. Medico-legal officer of the
municipality
 The revised implementing
rules and regulations (IRRS’s)
of R.A. 7305 or the Magna
Carta of Public Health Workers
 stipulated that there be one 3. Creating committees that shall
rural health physician to a advice local health agencies on
population of 20,000. various matters related to health
service operations.

The Inter-local Health Zone (ILHZ)

Local Health Boards
- 1 ILHZ = 1 DISTRICT HOSPITAL
 R.A. 7160 or Local Government Code
- This is based on a concept of the
was enacted to bring about genuine
District Health System, a term that
and meaningful local autonomy.
describes integrated health
- This will enable local governments to
management based on a defined
attain their fullest development as self-
administrative or geographical area.
reliant communities and make them
An ILHZ has a defined catchment
more effective partners in the
population within a defined
attainment of national goals.
geographical area. It is made up of
the following:
 Devolution refers to the act by which
1. Central or Core referral
the national government confers hospital
power and authority upon the various 2. A number of primary level
LGU’s to perform specific functions facilities like Rural Health
and responsibilities. Units and Barangay Health
 R.A. 7160 provided for the creation of Centers.
the Provincial Health Board and the
City/Municipal Health boards, or Local
Components of Interlocal Zone
Health Boards.
(ILHZ)
1. People – a health district has
The Functions of Local Health Boards are around 100,000 to 500,000
as follows: population
1. Proposing to the Sanggunian annual 2. Boundaries – there has to be
budgetary allocations for the clear boundaries between
operation and maintenance of ILHZs to establish
health facilities and services within accountability and
the province/city/municipality; responsibility
2. Serving as an advisory committee to 3. Health facilities – made up of
the Sanggunian on health matters; Rural Health Units, Barangay
and Health Centers that decide to
 work together as an including emergency services and provision
integrated health system for normal deliveries.
4. Health Workers – includes
1. Without in-patient beds
personnel of the DOH,
(example: Health centers, Out-
District or Provincial
patient clinics, Dental clinics)
Hospitals, Rural Health Units,
2. With in-patient beds (example:
Barangay Health Stations,
Infirmaries, Birthing facilities)
Private Clinics, NGOs and
Community Based
Organizations. Category B (Custodial Care Facility) – a
health facility that provides long term care,
including basic services like food and shelter
Levels of Health Care Delivery – to patients with chronic conditions.
- The DOH issued administrative (Example: Facilities for mental health,
order 2012-0012 (Rules and Drug abuse treatment facilities)
Regulations Governing the new
Classification of Hospitals and Other
Health Facilities in the Philippines) Category C (Diagnostic/Therapeutic Facility)
that provides for a new – facility for examination of human boy for
classification scheme of health the diagnosis of diseases disabilities.
facilities.
(Example: Clinical laboratories,
Radiologic facilities, Nuclear medicine
 Hospitals
facilities)
- Level 1 General Hospitals
- Level 2 Specialty Hospitals
- Level 3 Training Hospitals Category D (Specialized Out-Patient
 Specialty Hospitals Facilities) – performs highly specialized
procedures.
(Examples: Dialysis clinics,
 Other Facilities
Chemotherapy clinics, Rehabilitation
- Primary care facility
Stations, MedicalArts Unit)
- Custodial care facility
- Diagnostic, therapeutic facility
- Specialized outpatient facility

Category A (Primary level Facility) – a first

contact facility that offers basic services
Health Sector Reform: Universal To achieve the three strategic thrusts,
Health Care six strategic instruments shall be
optimized:
- Also called the Aquino Health
Agenda. The latest in a series of 1. Health financing –
continuing efforts of the instrument to increase
government to bring about health resources for health that
sector reforms. will be effectively
- UHC was built upon strategies of allocated and utilized to
two previous platforms: the initial; improve the financial
protection of the poor and
the vulnerable sectors.
Health Sector Reform Agenda and 2. Service delivery –
FOURmula One for health instrument to transform
the health service delivery
Goals and Objectives:
structure to address
1. Better health outcomes; variations in health
2. Sustained health service utilization and
financing; and health outcomes across
3. A responsive health socioeconomic variables.
system by ensuring that 3. Policy, standards, and
all Filipinos, especially the regulation – instrument to
disadvantaged group, ensure equitable access to
have equitable access to health services, essential
affordable health care. medicines, and
technologies of assured
quality, availability and
Strategic thrusts: the attainment of the safety.
goal of UHC is through the pursuit of three 4. Governance for health –
strategic thrusts: instrument to establish
A. Financial Risk protection mechanisms for efficiency,
through expansion in NHP transparency, and
enrollment and benefit delivery accountability, and
B. Improved access to quality prevent opportunities for
hospitals and health care fraud.
facilities 5. Human resources for
C. Attainment of the health-related health – instrument to
MDGs. ensure that all Filipinos
have access to
 professional health care A strategy that insures access to health care
providers that appropriate regardless of economic class. These are the
level of care. very reasons why World Health Organization
6. Health information – (WHO) has supported the global
instrument to establish a implementation of Primary Health Care. This
modern information strategy started in Sept. 6-12, 1978 during
system that shall: the First International Conference in primary
a. Provide evidence Health Cate in Alma Ata, Russia.
for policy and
program
development; “If we have to improve the health of our
b. Support for community, we also need to improve the
immediate and other components of our society like
efficient provision education, the environment, etc.”
of health care and
management of
province-wide The results of the conference are these
health system. declaration;

Alma Ata Declarations

 Health is a basic fundamental
right;
The Primary Health Care  There exists global burden of
as a Strategy health inequalities
populations;
among

 Economic and social

The improvement in the health society development is of basic
quality of the populace is a continuing importance for the full
challenge for societies and governments. In attainment of health for all; and
spite of the many advances, the vast majority  Governments have responsibility
of the population still barely meet the for the health of their people.
minimum standards for health care and
human development.
Definition of Primary Health Care
Hence, an overall approach in the delivery of (PHC)
health services is necessary – strategy that
engages both the health workers and the - According to Alma Ata Conference,
people themselves as partners and a strategy Primary Health Care is defined as an
that is affordable to the government yet still essential care based on practical,
effective and acceptable to the communities. scientifically sound and socially
 acceptable methods and
technology made universally
accessible to all individuals and
families through their full
participation and at a cost that the
community and country can afford
to maintain at every stage of their
development in the spirit of self-
reliance and self-determination.
Health for All: The Universal Goal
of Primary Health Care
“Health is enjoyed by all”
Main Objectives:
1. Promotion of health
lifestyles
2. Prevention of
diseases
3. Therapy for existing
condition
Key Elements for “Health for All”
1. Reducing exclusion and
social disparities in health
(Universal Coverage) –
everyone can access
health care, poor or rich.
2. Organizing health services
around people’s needs
and expectations (health
service reforms)
3. Integrating health into all
sectors (public policy
reforms)
4. Pursuing collaborative
models of policy dialogue
(leadership reforms)
5. Increasing stakeholders’
participation
Essential Elements of PHC
 E – education for
health (IEC materials)
 L – locally endemic
(regularly found
among particular
people or in a certain
area/present all year
round) disease control
 E – expanded program
on immunization
 M – maternal and child
health
 E – essential drug
 N – nutrition
 T – treatment of
communicable and
non-communicable
diseases
 S – safe water and
sanitation
Key Principles of PHC
1. (4A’s) - Accessibility,
affordability, acceptability
and availability
2. Support mechanisms
3. Multi-sectoral approach
4. Community participation
5. Equitable distribution of
health resource
 6. Appropriate technology
1. 4As
i. Accessibility – Usually refers
to the distance of a health
facility or the travel time
required for people to get
the needed service. This
requires the existence of a
facility within reasonable
distance from the catchment
required by the people are
offered in the health care
facility population or the
people it is meant to serve.
ii. Affordability – It is not only
in consideration of the
individual or family’s capacity
to pay for basic health
services. Particularly for
public health services, it is
also a matter of whether the
community or government
can afford these services.
iii. Acceptability – Means that
the health care offered is in
consonance with prevailing
culture and traditions of the
population.
iv. Availability – Is a question
whether the basic health
services required by the
people are offered in the
health care facilities or is
provided on a regular basis.
2. Support mechanism – there are
3 major resources:
i. People
ii. Government
iii. Private Sector (e.g., NGO,
church, …)
3. Multisectoral approach – reason
we engage to partnership and
linkages is (1) to be able to
maximize resources we have (2)
to capacitate the partnership –
to be able to learn with each
other
i. Intrasectoral Linkages
(Two-way referral sys) –
communication,
cooperation and
collaboration within the
health sectors.
ii. Intersectoral Linkages –
between the health sector
and other sectors like
education agriculture and
local government officials.
4. Community participation
- A process in which people
identify the problems and
needs and assumes
responsibilities themselves
to plan, manage, and
control.
5. Equitable distribution of health
resources
2 DOH programs to ensure
equitable distribution:
i. Doctor to the Barrion
(DTTB) Program
 o the deployment of - Safety
doctors to - Effectiveness
municipalities that - Affordability
are w/o doctors. - Simplicity
o Deployment to - Acceptability
unserved, - Feasibility and Reliability
economically - Ecological effects
depressed 5th or - Potential to contribute to
6th class individual and community
municipalities for development
2 years.
RNHSS -????
ii. Registered Nurses Health
R.A. 8423 – Traditional and
Enhancement and Local
Service (RN HEALS)
Alternative Medicine Act of 1997
o Training and (Juan Flavier)
program for Medical Plant Indication
unemployed nurse Use Preparation
o Deployed to 1. Lagundi Asthma cough and colds,
unserved, Decoction fever, dysentery,
economically pain, skin disease
depressed (scabies, ulcer,
municipalities for eczema), wounds
1 year. 2. Yerba Buena headache,
Decoction stomachache, cough
and cold,
6. Appropriate technology - Rheumatism,
Health technology includes: Arthritis
- Tools
- Drugs Infusion Massage sap
- Methods 3. Sambong antiurolithiasis
- Procedures and technique Antiedema
- People’s technology Decoction
- Indigenous technology 4. Tsaang Gubat diarrhea,
Decoction stomachache
5. Niyog-niyogan Antihelminthic
Criteria for Appropriate health Seeds are used
technology: 6. Bayabas washing wounds,
Decoction diarrhea, gargle,
 toothache
7. Akapulko antifungal
Poultice
8. Ulasimang Bato lower blood uric acid
Decoction (rheumatism and
gout)
Eaten Raw
9. Bawang hypertension, lowers
blood cholesterol,
toothache
Eaten raw/fried Apply on part
10. Amapalaya diabetes mellitus
Decoction Steamed (mild non-insulin
dependent)

Medical Plant Preparation

1. DECOCATION – boiling the plant
material in water for 20 min.
2. INFUSION – plant material is
soaked in hot water for 10 – 15
minutes.
3. POULTRICE – directly apply plant
material on the affected part,
usually in bruised, wounds and
rashes.
4. TINCTURE – mix the plant
material in alcohol