Geography and Socio-Demography

Summary of Health system in Transition(2011)

- Philippines has a total land area of 343,282 square kilometers, and a coastline stretched to
36,289 kilometers
- Its terrain is mostly mountainous, with narrow to extensive coastal lowlands.
- It has tropical and maritime climate, characterized by relatively high temperatures, high
humidity and abundant rainfall.
- Lowest temperature in mountain areas – 15.6 degree celsius(60) to 21.1(70) degree celsius –
December, January, February
- Highest temperature during dry season – 35 degree celsius(95) – December to May
- Country’s rainy season is from June to November
- The Philippine experiences an average of 20 typhoons each year during its rainy season due to
its location in the typhoon belt of Western Pacific
- Ph is along thenPacific Ring of Fire – large number of earthquakes and volcanic eruptions occur
- Economically-deprived areas – Bicol and Eastern Visayas Region
- Christian Malays – majority of the population
- 190 ethnic groups in the country – Tagalog – most widespread

A modern health care system to be responsive can be evidenced be at least four factors

1. Effectiveness of Medical Technology

2. Significantly Low Mortality Rate
3. Adequate Funds
4. Financial Organization/Insurance (Philhealth, SSS, GSIS)

Philipppine Health Care Organizational Structure

- The Philippine Health Care System is politically decentralized with the DOH as regulatory
authority
- DOH is mandated under its own charter to develop national plans, technical standards and
healthcare guidelines for all Filipinos.
o Accreditation and issuance of licences and permmits to operate
- MTPDP (Medium-Term Philippine Development Plan – mandates plans (blueprint of
development)
- LGU’s and private sector health agencies act as support institutions
- RHUs are characterized as primary level of healthcare
- LGU delivers public health services with the DOH providing technical assistance
- Provincial governments manage secondary and tertiary level facilities
- National Government retains management of a number of tertiary llevel facilities
- Private sector delivers services at all three levels of the system

Three Major Areas of Reforms

1. Health Service Delivery – provision of a multi-year budget for priority services, upgrading of the
physical and management infrastructure at all levels and the strengthening of technical
expertice in the DOH
 2. Health Regulation – pharmaceutical sectors
3. Health Financing - EXPANDING HEALTH INSURANCE

Health care Reforms

The Philippine Health System Review(2011), discloses various reforms have been instituted over the past
30 years (DOH, 2005)

1. Adoption of Primary Health Care (PHC) in 1979.

2. Integration of Public Health and Hospital Services in 1983 (EO 851)
3. Enactment of the Generics Act of 1988 (RA 6675)
4. Devolution of Health services to LGU’s as mandated by the Local Government Code of 1991 (RA
7160)
5. Enactment of the National Health Insurance Act of 1995 (RA 7875)
6. Launching by DOH the Health Sector Reform Agenda (HSRA) in 1999 as a major policy
framework and strategy to improve the way health care is delivered, regulated, and financed
a. Local Government Code (RA 7160 of 1991) changed the delivery of health services as it
gave local government units (LGU’s responsibility for and financial management of their
own health activities, with the DOH providing guidance and advice.
b. Enactment of the National Health Insurance of 1995 (RA 7875), which replaced the
Medicare Act of 1969 and established PhilHealth as the National Health Insurance
corporation which aimed to ensure universal coverage with financial access to quality
and affordable medical care for all Filipinos.

Philippines Health System Review (2011) conducted by the UP reveals that health reforms took off from
the 1991 move for decentralization when LGU’s were granted autonomy and responsibility for their own
health services, and when provincial governments were given responsibility for secondary hospital care.

Primary Health Care (PHC) in 1979. Was also meant to effectively utilize these system in order to control
or eradicate the immediate and specific health problems confronting Filipino communities by:

a. Strengthening and re-orienting existing specific programs in family planning, nutrtion, malaria
eradication, schistosomiasis control, cancer control, and others to conform to the thrust of the
peripheral services;
b. Development of a plan to eradicate tuberculosis by means of a strong program which will be
integrated with the health development at community levels

Integration of Public Health and Hospital Services in 1983 (EO 851). Reorganizing the ministry of health,
integrating the components of health care delivery into its field operation and for other purposes.

- SECTION 8. The Minister shall exercise supervision and control over the following staff, bureaus,
and special projects:
1. Bureau of Dental Health Services
2. Bureau of Foods and Drugs
3. Bureau of Health Services
4. Bureau of Medical Services
5. Bureau of Research and Laboratories
 6. Dermatology Research and Training Project, which is hereby renamed Dermatology
Research and Training Service
7. National Family Planning Office, which is hereby renamed Family Planning Service
8. Malaria Eradication Service
9. National Cancer Control Center, which is hereby renamed Cancer Control Center
10. National Nutrition Service, which is hereby renamed Nutrition Service
11. Radiation Health Office, which is hereby renamed Radiological Health Service
12. Schistosomiasis Control and Research Service

Medical centers and regional hospitals which are not listed above and which are located outside of
Metro Manila shall be under the supervision and control of the appropriate Regional Health Office.

- SECTION 11. The Minister shall exercise administrative supervision over the following entities:
1. Dangerous Drugs Board
2. Philippine Medical Care Commission
3. Schistosomiasis Control Council

Enactment of the Generics Act of 1988 (RA 6675)

It became a policy of the state to:

 Promote, encourage and require the use of generic terminology in the importation,
manufacture, distribution, marketing, advertising and promotion, prescription and dispensing of
drugs;
 Ensure the adequate supply of drugs with generic names at the lowest possible cost and
endeavor to make them available for free to indigent patients;
 Encourage the extensive use of drugs with generic names through a rational system of
procurement and distribution;
 Emphasize the scientific basis for the use of drugs, in order that health professionals may
become more aware and cognizant of their therapeutic effectiveness; and
 Promote drug safety by minimizing duplication in medications and/or use of drugs with
potentially adverse drug interactions.

Enactment of Health Insurance Act of 1995(RA 7975)

- Section 16. As amended by RA 10606, empowers the corporation to supervise the provision of
health benefits and to set standards, rules and regulations necessary to ensure quality of care,
appropriate utilization of services, fund visibility, member satisfaction, and overall
accomplishment of program objectives.

Accreditation – done on a voluntary basis

Philhealth Circular 54 s. 2012 – seeks to improve the access of Philhealth members and their
dependents to quality health care services through enhanced guidelines in engaging the IHCPs in
implementing the NHIP.

Bryan Turner(2002) Sociologist

- The study reveals that the most common nursing complaints were:
 o Subordination to the medical profession on all matters, even over standardized
regulations, and
o Difficult working conditions
- This situation is common in developed and developing nations around the world

Another study by Bryan Turner found that nurse dissatisfaction stemmed from:

1. Conflicting expectations from nurses and managers due to regulation of cost

2. Inability to provide comprehensive nursing care due to work
3. Loss of confidence in the healthcare system

Commonwealth of Australia – nurse dissatisfaction

1. Constant schedule changes

2. Work overloads due to high number of patients and paper works
3. Shift work
4. Lack of appreciation by superiors
5. Lack of provided childcare
6. Inadequate pay

Push factor

- Overabundance of RNs
- Lack of open employment position

Pull factor

- Economic benefits of international position

- Additional economic benefits of siging bonuses in the US
- Immigration benefits for individuals and families