FAR EASTERN UNIVERSITY – DR.
NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
HEALTH CARE DELIVERY
SYSTEM
 A nation’s health care delivery system has
a tremendous impact not only on the health
of its people but also on their total
development, including their
socioeconomic status.
 A discussion of the health care delivery
system often involves issues of cost and
challenges.
 Nations go through a struggle to overcome
multiple forces in efforts to advance the
nation’s health within the context of their
financial and political situations.
 The nurse is an essential member of the
health workforce in the country. For the
nurse to work efficiently within the health
care delivery system, an understanding of
the dynamic relationships among its
components is needed.
 Anderson and Mc Earlane (2011)
emphasized the role of the following
factors in shaping 21st century health that
further influence health care delivery
system:
FACTORS THAT INFLUENCE HEALTH
CARE DELIVERY SYSTEM
 Health care reforms
 Demographics
 Globalization
 Poverty and growing disparities
 Social disintegration
The DOH serves as the main governing body of
health services in the country.
The DOH provides guidance and technical
assistance to LGUs through the Center for Health
Development in each of the 17 regions.
 Provincial government is responsible
for administration of provincial and
strict hospitals.
 Municipal and city governments are in
charge of primary care through rural
health units (RHUs) or health centers.
 Satellite outposts known as barangay
health stations (BHSs) provide health
services in the periphery of the
municipality or city.
 As mentioned earlier, the Local
Government Code mandated the
devolution or decentralization of basic
health services.
 This means that LGUs have the
autonomy and responsibility to plan
and implement basic health services
(primary care) on behalf of their
constituents.
 This is a mandate for LGUs
Depending on the capability and
political will of the municipality /city
government, higher levels of services
may be provided.
 Thus, it is possible for a city or
municipality to administer a
secondary or even a tertiary hospital.
- For example: Ospital ng Maynila
Medical Center is tertiary
hospitals, is funded by the city
government of Manila.
In the Philippines, health services are provided
by the
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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 Government
 Private sector- for profit and
nonprofit agencies.
- On the National level, direction is
set by the Department of Health
(DOH) . By virtue of the mandate
of the local Government Code
(R.A. 7160), local government
units (LGUs) should have an
operating mechanism to meet the
priority needs and service
requirements of their
communities.
- This sector provides all levels of
services and accounts for a large
segment of health service
providers in the country.
- About 30% of Filipinos utilize
private health facilities.
- An estimated 60% of the national
health expenditure goes to the
private sectors.
- This sector also employs more
than 70% of the health
professionals in the Philippines
Romualdez, 2011)
Financing of health services is provided by
three major groups
 Government (national and
local)
 Private sources
 Social health insurance
- National Health Insurance
Act of 1995 (R.A. 7875)
created the Philippine
Health Insurance
Corporation (PhilHealth).
It is a tax-exempt
government corporation
attached to the DOH for
policy coordination and
guidance, and aims for
universal health coverage
of all Filipino citizen.
- In the Philippines health
care system is complex set
of organizations interacting
to provide an array of
health services.
Components of the Health Care Delivery
System as mandate of the Department of
Health (DOH) is to be responsible for the
following
 formulation and development of
national health policies, guidelines,
standards
 manual of operations for health
services and programs;
 issuance of rules and regulations,
licenses and accreditations;
 promulgation of national health
standards, goals, priorities and
indicators;
 development of special health
programs and projects and advocacy
for legislation on health policies and
programs.
The Primary Function of the Department of
Health:
 promotion
 protection
 preservation
 restoration of the health of the people
through the provision and delivery of
health services and through the
regulation and encouragement of
providers of health goods and services
(E.O. No. 119, Sec.
HEALTH CARE DELIVERY SYSTEM
 It is the totality of all policies,
infrastructures, facilities, equipment,
products, human resources, and
services that addresses the health
needs, problems and concerns of all
people.
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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
Health Care System
 An organized plan health services
(Miller Keane,1987)
Health Care Delivery
 rendering health care services to the
people.
Health Care Delivery System
 (Williams-Tungpalan, 1981) – the
network of health facilities and
personnel, which carries out the task
of rendering health care to the people.
Philippine Health Care System
 is a complex of organizations
interacting to provide an array of
health services (Dizon, 1977)
 It delineates the health care delivery
system in the Philippines, beginning
with the World Health Organization
(WHO) as this specialized agency of
the United Nations (UN) provides
global leadership on health matters.
 In the Philippines, health services are
provided by the government and the
private sector -for profit as well as
nonprofit, with the latter frequently
referred to as nongovernmental
organizations or NGOs.
 On the national level directions is set
by the Department of Health (DOH).
 By virtue of the mandate of the Local
Government Code (R.A. 7160), local
government units (LGUs) should have
an operating mechanism to meet the
priority needs and service
requirements of their communities.
 Basic health services are regarded as
priority services, for which LGUs are
primarily responsible.
Health System
 Consist of all organizations, people,
and actions whose primarily intent is
to promote, restore, or maintain
health.
Health System has 6 building blocks or
components
 Service Delivery
 Health workforce
 Information
 Medical products, vaccines, and technologies
 Financing
 Leadership and governance or stewardship
THE HEALTH CARE DELIVERY SYSTEM
WHO - World Health Organization
 Specialized agency of the United
Nation provides global leadership on
health matters.
 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). -The
WHO constitution states that its
objective is the attainment by all
peoples of the highest possible level
of health (WHO, 2006).
Core Functions:
 Providing leadership on matters
critical to health and engaging in
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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
partnerships where joint action is
needed.
 Shaping the research agenda and
stimulating the generation, translation
and disseminating valuable knowledge
WHO strategy on research has 5 goals
 Capacity in reference to capacity
building to strengthen national health
research systems
 Priorities to focus research on priority
health needs particularly in low-and
middle-income countries
 Standards to promote good research
practice and enable the greater sharing
of research evidence tools, and
materials
 Translation to ensure that quality
evidence is turned into products and
policy
 Organization to strengthen the
research culture within WHO and
improve the management and
coordination of WHO research
activities
 Setting norms and standards and promoting
and monitoring their implementations.
 Articulating ethical and evidence-based
policy options.
 Proving technical support, catalyzing
change, and building sustainable
institutional capacity
 In the past decade, WHO has worked
as a partner of the Philippine DOH in
the development and provision of
services towards the attainment of
health-related Millennium
Development Goals (MDGs).
THE MILLINEUM DEVELOPMENT
GOALS
 September 6-8, 2000- Millennium
Summit. World leaders in the UN
assembly participated.
 United Nations Millennium
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 member states is
to reduce poverty and achieve the 7
other targets. Now called Millennium
Development Goals (MDGs) by the
year 2015.
MILLENNIUM DEVELOPMENT GOALS
 Eradicate extreme poverty and
hunger
 Achieve universal primary
education
 Promote gender equality and
empower women
 Reduce child mortality
 Improve maternal health-mmr n
rh
 Combat HIV/AID, malaria and
other diseases
 Ensure environmental
sustainability
 Develop a global partnership for
development
SUSTAINABLE DEVELOPMENT GOALS
 Known as the Global Goals are a universal
are a collection of 17 global goals set by
the United Nations
 Assembly in 2015 for the year 2030. The
SDGs are part of Resolution 701 of the
United Nations General Assembly
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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 They are the blueprint to achieve a better
and more sustainable future for all. They
address the global challenges we face,
including those related to poverty,
inequality, climate, environmental
degradation, prosperity, and peace and
justice.
 The goals interconnect and in order to
leave no one behind, it is important that
we achieved each goal and target by 2030
17 GLOBAL GOALS (SUSTANAINABLE
GOALS)
 No poverty-end poverty in all its forms
everywhere
 Zero hunger-food security n improved
nutrition
 Good health and well being
 Quality Education
 Gender equality
 Clear water and sanitation
 Affordable and Clean energy
 Decent Work and economic growth
 Industry, Innovation, and infrastructure
 Reduces inequalities
 Sustainable cities and communities
 Responsible consumption and production
 Climate action
 Life below water
 Life on land
 Peace justice and strong institution
 Partnership for the goals
DEPARTMENT OF HEALTH
 The Department of Health (DOH) is the
national agency mandated to lead the
health sector towards assuring quality
health care to all Filipinos.
 The DOH vision is to be a global leader
for attaining better health outcomes,
competitive and responsive health care
system, and equitable health financing.
 Mission: statement is to guarantee
equitable, sustainable, and quality health
for all Filipinos, especially the poor, and to
lead the quest for excellence in health. .
(DOH, 2012b)
Major Roles
 Leader in health
 Enabler and capacity builder
 Administrator of specific services
The leadership role of the DOH is specifically
elucidated in Executive Order 102. series of
1999 in terms of the following functions
 Planning and formulating policies
of health programs and services
 Monitoring and evaluating the
implementation of health
programs, projects, research
training, and services
 Advocating for health promotion
and healthy lifestyles
 Serving as a technical authority in
disease control and prevention
 Providing administrative and
technical leadership in health care
financing and implementing the
National Health Insurance Law
FUNCTIONS OF THE DOH, As enabler and
capacity builder
 Providing logistically support to
LGUs the private sector, and other
agencies in implementing health
programs and services
 Serving as the lead agency in
health and medical research
 Protecting standards of excellence
in the training and education of
health care system
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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
As administrator of specific services, the DOH
is tasked to
 Serve as administrator of selected health
Goal
facilities at subnational levels that act as
referral centers for local health systems,
that is, tertiary and special hospitals,
reference laboratories, training centers,
centers for health promotion, centers for
disease control and prevention and
regulatory offices
 Provide specific program components for
conditions that affect large segments of
the population, such as TB, malaria,
schistosomiasis, HIV/AIDS and
micronutrient deficiencies
 Develop strategies for responding to
emerging health needs
 Provide leadership in health emergency
preparedness and response services,
including referral and networking systems
for trauma, injuries and catastrophic
events.
The DOH core values reflect adherence to the
higher standards of work
 Integrity
 Excellence
 Commitment
 Professionalism
 Teamwork
 Stewardship of the people
The Philippine Department of Health
HISTORICAL BACKGROUND
Vision
Pre-Spanish and Spanish period (before 1898)
HEALTH FOR ALL BY 2000 & HEALTH IN
THE HANDS OF THE PEOPLE BY 2020.
 THE DOH is the leader, staunch
advocate and model in promoting
“Health for all in the Philippines .
Mission
 Ensure accessibility and quality of
health care to improve the quality of
life of all Filipinos
 To raise the level of health of the
citizenry by helping comm. & families
to cope with the discontinuities in &
threats to health in such a way as to
maximize their potential for high-level
wellness.
 Guarantee equitable, sustainable and
Equality health for all Filipinos,
especially the poor and shall lead the
quest for excellence in health
 In partnership with the people, provide
equity & access & quality health
services especially to the marginalized
segment of the population
 The DOH shall do this by seeking all
ways to establish performance
standards for health human resources;
health facilities and institutions; health
products and health services that will
produce the best health systems for the
country.
 This, in pursuit of its constitutional
mandate to safeguard and promote
health for all Filipinos regardless of
creed, status, or gender with special
considerations for the poor and the
vulnerable who will require assistance
 Traditional health care practices especially
the use of herbs and rituals for healing
were widely practiced during these
periods.
 The western concept of public health
services in the country is traced to the first
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
dispensary for indigent patients of Manila
ran by a Franciscan friar that was began in
1577.
 In 1876 Medicos Titulares, equivalent to
provincial health officers were already
existing in 1888, a Superior Board of
Health and Charity was created by the
Spaniards which established a hospital
system and a board of vaccination among
others.
June 23, 1898
 Shortly after the proclamation of the
Philippine independence from Spain, the
Department of Public Works, Education
and Hygiene was created by virtue of a
decree signed by President Emilio
Aguinaldo.
September 29, 1898
 With the primary objective of protecting
the health of the American soldiers
General Orders No. 15 established the
Board of Health for the City of Manila.
July 1,1901
 A Board of Health for the Philippine
Islands was created through Act No. 157.
 This also functioned as the local health
board of manila. It truly became an Insular
Board of Health when Act Nos 307,308
dated Dec. 2, 1901, established the
Provincial and Municipal Boards
respectively completing the health
organization in accordance with the
territorial division of the islands.
October 26, 1905
 The Insular Board of Health proved to be
inefficient operationally so it was
abolished and was replaced by the Bureau
of Health under the Department of Interior
through Act No. 1407. Act No. 1487 in
1906 replaced the provincial boards of
health with district health officers
1912
-Act No. 2156 known as the Fajardo Act,
consolidated the municipalities into sanitary
divisions and established what is known as the
Health Fund for travel and salaries.
1915
 Act No. 2468 transformed the Bureau of
Health into a commissioned service called
the Philippine Health Service.
 This introduced a systematic organization
of personnel with corresponding civil
service grades and a secure system of civil
service entrance and promotion described
as the “semi-military system of public
health administration.
August 2, 1916
 The passage of the Jones Law also known
as the Philippine Autonomy Act, provided
the highlight in the struggle of the
Filipinos for Independence from the
American rule.
 The establishment of an elective Philippine
Senate completed an all-Filipino
Philippine Assembly that formed a
bicameral system of government.
 This ushered in a major reorganization
which culminated in the administrative
Code of 1917 (Act 2711) which included
the Public Health Laws of 1917
1932
 Because of the need to better coordinated
public health and welfare services, Act No.
4007 known as the
 Reorganization Act of 1932, reverted back
the Philippine Service into the Bureau of
Health, and combined the
 Bureau of Public Welfare under the Office
of the Commissioner of the Health and
Public Welfare
1935-1945
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 The Philippine Commonwealth and the
Japanese Occupation
May 31, 1939
 Commonwealth Act No. 430 created the
Department of Public Health and Welfare
but the full implementation was only
completed through Executive Order No.
317, January 7,1941. Dr. Jose Fabella
became the first Department Secretary of
Health and Public Welfare in 1941.
1942
 During the period of the Japanese
occupation, various reorganization 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.
 This resulted in the split of the Department
with transfer of the Bureau of Public
Welfare (which became the Social Welfare
administration) and the Philippine General
Hospital to the Office of the President.
Another was created between the curative
and preventive services through the
creation of the Bureau of Hospitals which
took over the curative services.
 Preventive care services remained under
the Bureau of Health. This order also
established the Nursing Service Division
under the Office of the Secretary.
January 1, 1951
 The office of the President of the Sanitary
District was converted into a public health
Unit, carrying out 7 basic health services:
Maternal and child health, environmental
health, communicable disease control, vital
statistics, medical care, health education
and public health nursing.
 This was carried out in 81 selected
provinces. The impact to the community
was strong. It directly resulted in the
passage of the Rural health Act of 1954
(RA 1082). This Act created more rural
health unites and crated posts for
municipal health officers among other
provisions.
February 20,1958
 Executive Order No. 288 provided for
what is described as the” most sweeping”
reorganization in the history of the
department at that period.
 This came about an effort to decentralize
governance of health services.AN Office
of the Regional Health Director was
created in 8 regions and all health services
were decentralized to the regional,
provincial and municipal levels. Bureaus
were limited to staff functions such as
policy making and development of
procedures.
 RHUs were made as integral part of the
public health care delivery system.
1970
 The Restructured Health V=Care Delivery
System was conceptualized. It classified
health services into primary, secondary,
and tertiary levels of care.
 This further expanded the reach of the
rural health units. Under this concept the
public health nurse to population ratio was
1:20,000.
 The expanded role of the public health
nurse was highlighted.
June 2,1978
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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 With proclamation of martial law in the
country, {residential Decree 1397 renamed
the Department of Health to the Ministry
of Health. Secretary Gatmaitan became the
first Minister of Health.
December 2,1982
 Executive Order No. 851 signed be the
President Ferdinand E. Marcos
reorganized the Ministry of Health as an
integrated health care delivery system
through the creation of the Integrated
Provincial Health Office which combines
public health and hospital operations under
the Provincial Health Officers.
April 13, 1987
 Executive Order No.119 “Reorganizing
the Ministry of Health “by President
Corazon C. Aquino saw a major change in
the structure of the ministry. It transformed
the Ministry of Health back to the
Department of Health.
EO 119
 clustered agencies and programs under the
Office for Public Health Services, Office
for Hospital and Facilities Services.
 The Field Offices were composed of the
Regional Health officers and National
Health facilities.
- The latter was composed
of National Medical
centers, the Special
Research Centers and
Hospitals. Five Deputy
minister positions were
also created.
October 10,1991
 Republic Act 7160 known as the Local
Government Code provided for the
decentralization of the entire government.
 This brought about a major shift in the role
and functions of the Department of Health.
 Under this law, all structures personnel
and budgetary allocations from the
provincial health level down to the
barangays were devolved to the local
government units (LGUs) to facilitate
health service delivery. The department of
Health changed its role from one of
implementation to one of governance
May 24, 1999
 Executive Order No. 102 “Redirecting the
Functions and Operations of the
Department of Health” by President
Joseph E. Estrada granted the DOH to
proceed with its Rationalization and
Streamlining Plan which prescribed the
current organizational, staffing and
resource structure consistent with its new
mandate, roles and functions post
devolution.
EO 102
 mandates the Department of Health to
provide assistance to local government
units, people’s organization and other
members of civic society in effectively
implementing programs, projects and
services that will promote the health and
well-being of every Filipino; prevent and
control diseases among population at risks,
protect individuals, families and
communities exposed to hazards and risks
that could affect their health and treat ,
manage and rehabilitate individuals
affected diseases and disability.
1994-2004
 Development of the Health Sector Reform
Agenda which describes the major
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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
strategies, organizational and policy health care services, new centers of
changes and public investments needed to authority for local health services emerged.
improve the way health care is delivered,  These consist of provincial, city, municipal
regulated and financed. governments, including an autonomous
regional government and a metropolitan
2005 ongoing authority.
 Each center controls a portion of the health
 Development of a plan to rationalize the
care system as part of its political and
bureaucracy in an attempt to scale down
administrative mandate. Now, provincial
including the Department of Health.
governments operate the hospital system.
Provincial and District Hospitals, while
LOCAL HEALTH SYSTEM and city. -Municipal governments operate the
DEVOLUTION of HEALTH SERVICES Health Centers (HC) /Rural Health Units
(RHU) and Barangay Health Stations.
Historical background  One of the most significant laws that
radically changed the landscape of health
care delivery system in the country is RA
 For over forty years after post war
7160 or commonly known as Local
independence, the Philippine health care
Government Code.
system was administered by a central
agency based in Manila.
 This control system was agency provided
the singular sources, policy direction,
technical and administrative supervision to
all health facilities nationwide.
 In 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, known as Republic Act
7160.
 The Code devolved basic services for
agriculture extension, forest management,
health services, barangay (township) roads
and social welfare to Local Government
Units.
 In 1992, 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.
 Devolution made local government
executives responsible to operate local

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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)

The Code aims to

 Transform local government units into self-reliant communities
 Active partners in the attainment of national goals through a more responsive and accountable
local government structure instituted through a system of decentralization. 1993, health services
were devolved or transferred from the Department of health to the local governments and the
rural health units (RHUs) and barangay health stations (BHSs) to the municipal governments.
 As the consequences, the organizational structure of the Department of Health and local government
units were changed.

ORGANIZATIONAL STRUCTURE OF THE PROVINCIAL GOVERNMENT

GOVERNOR

PROVINCIAL HEALTH

PROVINCIAL HEALTH

PROVINCIAL DISTRICT
OTHER HEALTH
HSOPITAL
HOSPITAL AND MEDICAL
FACILITIES

MUNICIPAL HEALTH
OFFICE

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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)

ORGANIZATIONL STRUCTURE OF THE MUNICIPAL GOVERNMENT

OFFICE OF THE
MAYOR

MUNICIPAL HRALTH
BOARD

MUNICIPAL HEALTH
OFFICE

RURAL HEALTH
BARANGAY HEALTH
UIT/HEALTH CENTER
STATION

 Each province, city and municipality have a local Health Board (LHB).

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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 This body is a good venue for making the local health system more responsive to the needs of the
people. It is mandated to propose annual budgetary allocations for the operation and maintenance of
health facilities and services within the municipality, city or province.
 At the provincial level, it is composed of the governor (chair), provincial health officer (Vice chair),
chairman of the Committee on Health of the Sanggunian Panlalawigan, DOH representative and
NGO representative.
 At the city and municipal level, the LHB is composed of the Committee on health of the Sanggunian
Bayan, DOH representative and NGO representative
 At the municipal level, many public health nurses have been appointed as DOH representative. This
means that they have been retained by the DOH.
 Many of them however dual functions-those of a public nurse and those of a DOH representative.
 Many of the local government units “cannot afford” to hire a replacement.
 The DOH has allowed this set up as a form of a support to low-income municipalities

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COMMUNITY HEALTH NURSING LECTURE (NCM 104)

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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 The shift in the leadership in health care from the national government to the LGUs has resulted in
both the improvement and deterioration of health care delivery.
 There are LGUs that are committed to health and are innovative while they are those that re just
interested in the purchase of supplies and medicines,
 Some LGUs have the financial capability to support their own health care delivery system while
others do not have adequate financial resources.
 It has been established that an LGUs financial capability, a dynamic and responsive political
leadership and community empowerment are the important ingredients of an effective local health
system.

CLASSIFICATION of HEALTH FACILITIES (DOH AO -012A)

 DOH issued Administrative Order 2012-0012 that provides for a new classification of health
facility. -DOH Administrative Order 2012-0012(Rules and Regulations Governing the New
Classification of Hospitals and Other Health Facilities in the Philippines).

Hospitals Other Health Facilities

General A. Primary Care facility
Level 1 B. Custodial Care Facility
Level2 C. Diagnostic/Therapeutic Facility
Level 3
(teaching/training)

Specialty D. Specialized Outpatient Facility

Category A. Primary Health Care Facility

 The first -contact health care facility that offers basic services including emergency services and
provision for normal deliveries
1. Without in-patient beds like health centers, outpatient clinics, and dental clinics
2. With in-patient beds- a short stay facility where the patient spends on the average of one or two days
before discharge. Examples are infirmaries and birthing (lying in) facilities

Category B Custodial Care Facility

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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
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
-Examples: are custodial psychiatric facilities, substance. drug abuse treatment and rehabilitation centers,
sanitaria/ leprosaria and nursing homes

Category C Diagnostic /therapeutic facility

-A facility for the human body, specimens from the human body for the diagnosis, sometimes treatment of
disease, or water for drinking water analysis.

The test covers the pre analytical, analytical and post analytical

 Laboratory facility such as but not limited to the following:

- Clinical laboratory
- HIV testing laboratory
- Blood service facility
- Drug testing laboratory
- Newborn screening lab.
- Laboratory for drinking water analysis

 Radiologic facility providing services such as X-ray, CT scan, mammography, MRI, and
ultrasonography 3. Nuclear medicine facility- a facility regulated by the Philippine Nuclear Research
Institute utilizing applications of radioactive materials in diagnosis, treatment or medical research,
with the exception of the use of sealed radiation sources in radiotherapy as in internal radiation
therapy

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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)

Category D Specialized outpatient facility

 A facility that performs highly specialized procedures on an outpatient basis

 Examples are dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic center/ clinic
cancer radiation facility and physical medicine and rehabilitation center/ clinic.

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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)

NEW CLASSIFICATION OF GENERAL HOSPITALS

HOSPITALS LEVEL 1 LEVEL 2 LEVEL 3

Clinical services for in Consulting specialists Level 1 plus: Level 2 plus:

patient in: Departmentalized Teaching /training with
Medicine clinical service accredited residency
Pediatrics training program in four
Obstetrics- Gynecology major clinical services
Surgery
Emergency and
outpatient services Respiratory unit Physical medicine and
Isolation facilities rehabilitation unit
Surgical /maternity General ICU
facilities Ambulatory surgical
High risk pregnancy unit
Dental Facility NICU clinic
Dialysis clinic

Ancillary services Secondary clinical Tertiary clinical Tertiary clinical

laboratory Blood laboratory laboratory with
station histopathology
First level X-ray Second level X-ray with Blood bank
Pharmacy mobile unit Third level

PHILIPPINE HEALTH AGENDA 2010-2022

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

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BSN-2A
 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 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”.

PRIMARY HEALTH CARE (PHC)

Briefly History

 The core strategy is the effective provision of

essential health services.
 -PHC was declared during the First International
Conference on Primary Health Care held in
Alma Ata,USSR on September 6-12 1978
by WHO and UNICEF.
 Together they expressed the need for concerted
effortsby all governments and health and

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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
development workers for the protection and
promotion of health of all the people.
Legal Basis of PHC in the Philippines
 Letter of instruction (LOI) 949 signed by
Pres. Marcos on October 19, 1979.
 Making the Philippines the first country in
Asia to embark on meeting the challenge
of PHC.
 It must be noted that even prior to LOI
949, which provided impetus to the then
Ministry of Health, there were several
health workers, nongovernmental
organizations (NGOs) and church
organizations offering community-based
health programs in the rural areas of
Visayas and Mindanao, applying the spirit
of PHC even before it was formally
adopted by the government.
 The Alma ATA Declaration on Primary
Health Care emerged from this conference.
The Alma Ata conference made the
following declarations
 Health is a basic fundamental right
 There exists global burden of health
inequalities among populations
 Economic and social development is of
basic importance for the full attainment of
health for all 4. Governments have a
responsibility for the health of their
people.
 Basic to the PHC declaration is the
common view that health “is a state of
complete, physical, mental, and social
well-being, and not merely the absence of
disease or infirmary “
 Viewing health from holistic perspective,
beyond just physical and mental maladies,
the WHO has put equal emphasis on the
social dimensions of health, that wellness
can be achieved by considering different
factors that interdependently influence the
health of the population,
 such as thenvironment, education, social
services and politics/ leadership.
 A healthy population has the capability to
contribute more to its development. By
emphasizing the people’s right to health,
the government is driven to increase
investment on health care.
 The WHO recommends governments to
allocate 5% of the gross national product
(GNP) to health services from 2005 to
2007 was only 3.3 % of the GNP
5 A’s (4As)
Accessible
 The WHO guideline states that for these
health care facilities to be considered
accessible, they must be within 30
minutes from the communities. BHSs are
facilities intended to provide accessible
health services at the community level.
Attainable
Affordable
 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. One
of the factors the WHO considers in
determining affordability of health care is
the out of pocket expenses for health care.
 This is the actual cost to the family for
health services lea any coverage of
insurance. In the Philippines, the
government health insurance is covered
through Phil health.
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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 There are other health insurance policies
offered by private companies or health
management organization.
Acceptable
 means that the health care offered in in
consonance with the prevailing culture and
traditions of the population.
Availability
 is a question of whether the basic health
services require by the people are offered
in the health care facilities or id provided
on a regular and organized manner.
 PHC as a service delivery policy of the
DOH permeates all strategies and thrusts
of government health programs from the
national to the local and community levels
 PHC is a complete turn-about from
disease-oriented, curative, hospital based,
and urban centered health care to
preventive, people centered, and
community-based health care.
The WHO defined PHC:
 Essential health care made universally
accessible to individuals and families in
the community by means acceptable to
them, through their full participation and
at a cost that the community and country
can afford at every stage of development.
 According to Alma Ata Declaration, PHC
“is essential health care based on practical,
scientifically sound and socially
acceptable methods and technology made
universally accessible to individuals and
families in the community through their
full participation and at a cost to maintain
at every stage of their development in the
spirit of self-reliance and self-
determination”
 The universal goal of PHC as stated in
the Alma ATA Declaration is “Health for
all” by the year 2000. -Health for all
means an acceptable level of health for
all the people of the world through
community and individual self-reliance.
 This policy agenda of “health for all by the
year 2000” technically was a global
strategy employed for achieving their main
objectives.
Main Objectives
 Promotion of healthy lifestyles
 Prevention of diseases
 Therapy for existing conditions
 President Marcos signed the LOI 949 that
has an underlying theme” Health in the
Hands of the People by 2020”
5. 5 key ELEMENTS
 The WHO has identified 5 key elements to
achieving the goal “health for all”
- Reducing exclusion and social disparities
in health (universal coverage)
- Organizing health services around
people’s needs and expectations (health
service reforms)
- Integrating health into all sectors (public
policy reforms)
- 4, Pursuing collaborative models of policy
dialogue (leadership reforms)
- Increasing stakeholder participation
The Alma Ata Declaration listed 8 essential
health services using the ACRONYM
(ELEMENTS)
E-education for all
L Locally endemic disease control
E expanded Program for immunization
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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
M maternal and child health including responsible
parenthood
E essential drugs
N nutrition
T treatment of communicable and non-
communicable diseases
S safe water and sanitation
Principles of PHC AND STRATEGIES
 Accessibility, affordability, acceptability
and availability
 Support mechanism
 Multisectoral approach
 Community participation
 Equitable distribution of health resources
 Appropriate technology
Health programs according to the 4As
 Botika ng Bayan and the Botika ng
barangay
 Ligtas sa Tigdas ang Pinas” mass measles
immunization campaign. Children aged 9
months to below 8 years old. The two
were vaccinated against measles and
rubella
LEVELS OF PREVENTION
Health promotion activities enhance resources
directed at improving well-being.
Disease prevention activities protect people from
disease and the effects of disease.
3 Levels of Prevention
 Primary Prevention
 Secondary Prevention
 Tertiary Prevention
PRIMARY PREVENTION
Relates to activities directed at preventing a
problem before it occurs by altering susceptibility
or reducing exposure for susceptible individuals.
Health promotion efforts enhance resiliency and
protective factors and target essentially well
population.
2 Elements
 General health promotion
 Specific protection
Example of primary prevention: Promotion of
good nutrition, provision of adequate shelter and
encouraging regular exercise
Specific protection efforts
 Reduce or eliminate risk factors and
include such measures as immunization,
and water purification.
SECONDARY PREVENTION
 Refers to early detection and prompt
intervention during the period of early
disease pathogenesis.
 It was implemented after a problem has
just begun but before signs and symptoms
appear and target those population who
have risk factors
 Example: Mammography, Blood pressure
screening, newborn screening and mass
sputum examination for pulmonary
tuberculosis
 Secondary prevention is also directed
toward prompt intervention to prevent
worsening conditions of the affected
population.
 This includes measures during the early
stage of disease to prevent complications.
 Teaching how to Oresol to her child
suffering from diarrhea to prevent
dehydration and administering vitamin A
capsules to children with measles.
TERTIARY PREVENTION
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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 Targets population that have experienced
disease or injury and focuses on limitation
of disability and rehabilitation.
 Aims of tertiary prevention are to reduce
the effects of disease and injury and to
restore individuals to their optimal level of
functioning.
 Examples: Teaching how to perform
insulin injection techniques and disease
management to a patient with diabetes,
referring a patient with spinal injury for
occupational and physical therapy and
leading a support group for cancer patients
who have undergone cancer treatment such
as surgery, chemotherapy and radiation
therapy.

Much of community health nursing practice is

directed toward preventing the progression of
disease at the earliest period or phase feasible
using the appropriate level (s) of prevention. For
example, when applying “levels of prevention
“concerning malnutrition among young children
in a community, a nurse might perform the
following interventions:
 Educate pregnant women on the
benefits of breastfeeding (Primary
Prevention)
 Conduct periodic Operation Timbang
(Secondary Prevention)
 Provide nutrition education to mothers
of children with severe malnutrition
(Tertiary Prevention)

EXAMPLES OF LEVELS

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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)

• LEVEL OF PREVENTION
DEFINITION OF Primary (health Secondary (early Tertiary (limitation of disability and
CLIENT SERVED* promotion and diagnosis and rehabilitation)
specific prevention) treatment)
Individual Dietary teaching HIV testing Teaching new clients with diabetes
during Screening for to administer insulin
pregnancy cervical cancer Exercise therapy after stroke
Immunizations
Family (two or more Education or Dental examination Skin care for incontinent patients
individuals bound by counseling regarding Diabetes screening Mental health counseling or referral
kinship, law, or living smoking, dental for family at risk for family in crisis (grieving or
arrangement and with care, or nutrition experiencing a marital conflict)
common emotional Adequate housing
ties and obligations)
Mothers’ class on Vision screening of Dietary instructions and monitoring
breastfeeding first- for family
Education for drug grade class Mass with overweight
abuse prevention for sputum members
high school students examination in a Group counseling for grade school
lowincome children with asthma
neighborhood Exercise program for diabetics at a
Hearing tests at a center for the elderly
center for the elderly
Community and Fluoride water Organized screening Alcoholics Anonymous and other
population (aggregate supplementation programs for self-help
of people sharing Environmental communities (e.g., groups
space over time sanitation Removal health fairs) Mental health services for military
within a social of VRDL screening for veterans Shelter and relocation
system; population environmental marriage license centers for fire, typhoon, or
hazards applicants in a city earthquake victims Emergency
groups or aggregates
medical services
with power relations
Community mental health services
and common needs or for chronically mentally ill Home
purposes) care services for
chronically ill

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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)

CABINGAO,B
BSN-2A
 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
UNIVERSAL HEALTH CARE
 Filipinos will begin benefiting from the
Universal Health Care (UHC) Act this
year, with every citizen entitled to health
coverage that will lower out of pocket
health expenses.
 The passage of the law was considered a
landmark for the Duterte administration as
lawmakers who championed the bill
gathered in Malacañang for a special
ceremony last February 20. It was there
that President Rodrigo Duterte affixed his
signature on the long-awaited law.
 The passage of Republic Act No 11223
was no easy feat. It was hailed as path-
breaking as it set the direction for the
reform of the health care sector in the
Philippines.
 The World Health Organization earlier
urged the Philippine government to make a
“real investment” in health care, as it
would save lives.
 But ensuring universal health care for all
Filipinos does not come cheap.
The following are the 8 things the citizen to
expect:
1. ALL Filipinos are covered
 Every single Filipino citizen is
automatically enrolled into the newly-
created National Health Insurance
Program (NHIP).
The program classified membership into two
types:
Direct contributors
 those who pay PhilHealth premiums, are
employed and bound by an "employer-
employee relationship," self-earning,
professional practitioners, and migrant
workers. Members’ qualified dependents
and lifetime members are also included.
Indirect Contributors
 Those not considered as direct
contributors, along with their qualified
dependents, whose health premiums are
subsidized by the government
 All Filipinos will be granted “immediate
eligibility” and access to the full spectrum
of health care which includes preventive,
promotive, curative, rehabilitative, and
palliative care.
 This can be expected for medical, dental,
mental, and emergency health services.
 Filipinos will also be enrolled with a
primary health care provider of their
choice.
 The primary care provider is the health
worker they can go and seek treatment
from for health concerns. -They will also
serve as the person in charge of referring
and coordinating with other health centers
if patients need further treatment.
 Citizens will not need to present any
PhilHealth ID to avail of these benefits.
 Meanwhile, poor Filipinos or those who
are located in geographically isolated
areas will also be given priority when
ensuring access to health services.
2. It is not completely free
 -Contrary to what some people may think,
UHC does not mean every single health
expense will be made free.
 -The law outlines those basic services
accommodations will be covered by
PhilHealth.
 -As a patient, that means that if you’re
admitted in a hospital, you can expect
regular meals, a bed in a
 -The law outlines those basic services
accommodations will be covered by
PhilHealth.
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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 -As a patient, that means that if you’re
admitted in a hospital, you can expect
regular meals, a bed in a shared room with
fan ventilation, and a shared toilet and bath
to be covered.
 All are also entitled to an “essential
health benefit package,” which
includes primary care, medicines,
diagnostic, and laboratory tests. It
also includes preventive, curative,
and rehabilitative services. -It will
no longer be free when one wants to
stay in a hospital room offering
private accommodation, air
conditioning, telephone, television,
and meal choices, among others.
 -Meanwhile, public and private hospitals
are expected to allocate a certain portion
of their beds as basic accommodations in
the following amounts:
 -Government hospitals – at least 90% of
beds
 -Specialty hospitals – at least 70% of beds
 -Private hospitals – at least 10% of beds
 The law also states that if the patients
need to pay for extra expenses, their “co-
payment or what is paid on top of basic
services should be regulated by the DOH
in public hospitals
 This means that you should know what to
expect in terms of bills, as opposed to
being shocked after treatment
 Aside from this, current case rates or
packages PhilHealth has crafted for certain
diseases will remain. -But together with
the DOH, PhilHealth is expected to work
towards including more needs a person
may have for a disease in its case rates.
 The two agencies are also expected to craft
and implement outpatient benefit services
to be covered by the National Health
Insurance Programs within 2 years after
the law takes effect.
3. PhilHealth will become the “national
purchaser” of health goods and services
 This means that PhilHealth will be in
charge of paying health care providers like
hospitals and clinics for services given to
Filipinos.
 This is already a job PhilHealth carries out
but the universal health care law wants to
pool more funds so it can cover all
Filipinos and eventually, more services.
 Allocating more funds to PhilHealth will
also strengthen its negotiating power with
health care providers, which will
foreseeably improve the quality of services
and lower health costs.
 Funds for PhilHealth will be sourced from
the following:
 Philippine Amusement and Gaming
Corporation – 50% of national
government’s share
 Philippine Charity Sweepstakes Office
(PCSO) – 40% of its charity fund, net of
document stamp tax payments, and
mandatory PCSO contributions
 Premium contributions of direct
contributory members
 By giving PhilHealth more funds, a goal of
the UHC is to make PhilHealth the
national purchaser of medicines. -This can
lower the cost of medicines as these will
be bought in bulk.
 Another goal is to have quality of health
services improve as PhilHealth can set as a
requirement for payment and contracting,
standards for health care providers.
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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
4. DOH will still be in charge of “population-
based” health services
 While PhilHealth, along with other private
health insurance companies, is expected to
cover services for individuals, the DOH is
still in charge of delivering health services
that cover entire populations.
 Think of these as programs for disease
surveillance, health promotion campaigns,
and mass immunization campaigns.
 The DOH will do this by contracting
public health care providers in cities and
provinces.
5. Health systems will become city-wide and
province-wide
 Provinces and highly urbanized cities will
now be in charge of overseeing health
services in areas as opposed to the current
set-up where municipalities are tasked
with managing their own health centers.
 The DOH will need to work with the
Department of the Interior and Local
Government (DILG) to have province- and
city-wide health systems or networks in
about two years after the law takes effect.
 For this, one can imagine as an example,
Rizal overseeing its province-wide health
care network of clinics and hospitals
compared to each municipality in Rizal
taking care of its own health center alone.
Similarly, highly urbanized cities like
Cebu or Makati will oversee their own
health care network compared to single
barangays being in charge of a health
center.
 Having access to health networks
province-wide can address the problem of
inadequate access to health services due to
lack of funds in barangays or
municipalities.
 Provincial and city health boards will be in
charge of pooling and managing a special
health fund to finance and improve health
services for residents. PhilHealth’s income
will also be channeled to this special
health fund.
6. Return service in the public health sector
 Graduates of health and health-related
courses who received government-funded
scholarships will be required to work in
the public health sector for at least 3 full
years. This will address the need for health
workers across the country.
 They will be paid by and under the
supervision of the DOH. Those who serve
for an extra two years will also be given
incentives, which will be determined by
the DOH.
 Meanwhile, graduates of health courses in
state universities and colleges and private
schools are encouraged to work in the
public sector.
7. A “Health Technology and Assessment
Council” (HTAC) will be created
 Another important feature of the law is the
creation of the HTAC – a group of health
experts who will be responsible for
evaluating latest health developments and
recommending their use to DOH and
PhilHealth. -The HTAC will be
responsible for assessing the safety and
effectiveness of health technology,
devices, medicines, vaccines, health
procedures, and other health-related
advances developed to solve health
problems.
 Reviewing the social, economic, and
ethical issues when using these
technologies or programs is also required.
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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
 The HTAC will be attached to the DOH
for the first 5 years after the law is
implemented. After this, it will become an
independent body attached to the
Department of Science and Technology.
8. Health information will be collected
 Both public and private hospitals and
health insurers will be required to maintain
a health information system that will
contain electronic health records,
prescription logs, and “human resource
information.”
 This system will be developed and funded
by DOH and PhilHealth. It will also be
subject to patient confidentiality rules and
data privacy laws.
LEGAL BASIS
 Universal Health Care (UHC) (Kalusugan
Pangkalahatan) also called the Aquino
Health Agenda is the latest in a
 series of continuing efforts of
the government to bring about
sector reforms. Was launched
through Administrative Order
2010-0036. UHC is [planned for
implementation until 2016
(DOH, 2110) UHC was built
upon the strategies of two
previous platforms of reform:
 The initial Health sector reform agenda
(1999-2004)
 FOURmula One (F1) for heath (2005-
2010)
BACKGROUND AND RATIONALE
RATIONALE:
 Health sector reforms are intended to bring
about equity in health care delivery.
Survey data show that this has not been
achieved as of yet, despite health sector
reforms since 1999.
 A DOH and PhilHealth review highlighted
the need to improve health-related
financial risk protection among Filipinos.
 More importantly, PhilHealth benefit
delivery was found to be the lowest among
the target population-the poorest quintile.
 The concern on inequitable access to
health resources has not been resolved.
 Neglect of public hospitals and health
facilities due to inadequate health
budgets has been observed. -As of
October 2010, a total of 892 RHUs and
99 government hospitals had yet to
qualify for accreditation by PhiHealth.
 Data show that the poorest of the
population are the main users of
government 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.
 -Finally, renewed efforts to achieve health
related MDGs are in order.
 The MDG 4 target is to reduce maternal
mortality rate from 209 maternal deaths
/100,000 live births in 2990 to 52 deaths
per 100,000 live births by 2015.
 To address these challenges, UHC
(Kalusugan Pangkalahatan) was launched
through Administrative Order 2010-0036
(DOH, 2010)
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 FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)

GOALS, OBJECTIVES AND THRUSTS  Human resources for health- instrument to

Goals:
 Better health outcomes
 Sustained health financing
 A responsive health system by ensuring that all
Filipinos, especially the disadvantaged group,
have equitable access to affordable health care.
STRATEGIC THRUSTS
 Financial risk protection through
expansion in NHIPP enrollment and
benefit delivery’
 Improves access to quality hospitals and
health care facilities
 Attainment of the health related MDGs
ensure that all Filipinos have access to
professional health care providers capable
of meeting their health needs at the
appropriate level of care.
 Health Information- instrument to
establish a modern information system that
shall:
a. Provide evidence for policy and
program development
b. Support for immediate and efficient
provision of health care and
management of province-wide health
system

STRATEGIC INSTRUMENTS
 Health financing- instrument to increase
resources for health that will be effectively
allocated and utilized to improve the
financial protection of the poor and the
vulnerable sectors.

 Service delivery- instrument to transforms

the health service delivery structure to
address variations in health services
utilization and health outcomes across
socioeconomic variables.

 Policy, standards and regulation-

instrument to ensure equitable across to
health services essential medicine and
technologies of assured quality availability
and safety.

 Governance for health- instrument to

establish the mechanism foe efficiency,
transparency, and accountability and
prevent opportunities for fraud.

CABINGAO,B
BSN-2A