Week 2 - The Healthcare Delivery System
The health care Delivery system was restructured that
brought about a major changes in terms of health care
in the phil.
1. Expansion of the roles of the public health nurse
and midwives in the health centers and rural
health units
2. Theres a strong involvement of the private
sectors comprising 50% of the health system
3. DOH serves as the main governing body of the
health services in the country. The DOH
provides the guidance and technical assistance
to LGU’s through the center for health
development in each of the 17 regions.
4. Provincial gov’t are responsible for the
administration provincial and district hosp.
5. 5Municipal and city gov’t are in charged of the
primary care through rural health units (RHU) or
health centers.
6. Satellite outpost known as barangay health
stations (BHS) Provide health services in the
pheripery of the municipality or city.
World Health Organization – International
DOH – National
WHO is our international partners in health. As they
provide leadership on matters critical to health and
engaging in partnership where joint action is needed,
WHO objective is the attainment by all people of the
highest possible of health (WHO,2006)
WHO was established on April 7, 1948. since then, April
7 has been celebrated each year as”. WORLD HEALTH
DAY”. With its Headquarters in GENEVA ,
SWITZERLAND.
WHO has 150 members state and offices and six
regional offices for, Africa, the America, eastern
Mediterranian , Europe, Southeast asia and western
pacific. The phil. Is a member of the western pacific,
which holds office in manila.
DOH is a national agency mandated to lead the health
sector towards assuring quality health care for all
Filipinos
WHO is the directing and coordinating authority for
health within the United Nations system. It is
responsible for providing leadership on global health
matters, shaping the health research agenda, setting
norms and standards, articulating evidence-based policy
options, providing technical support to countries and
monitoring and assessing health trends.
Established 7 April 1948. – a date we now celebrate
every year as World Health Day. Headquarters in
Geneva, Switzerland
What we do?
WHO works worldwide to promote health, keep the
world safe, and serve the vulnerable.
Our goal is to ensure that a billion more people have
universal health coverage, to protect a billion more
people from health emergencies, and provide a further
billion people with better health and well-being.
Where we work?
We support Member States as they coordinate the
efforts of multiple sectors of the government and
partners – including bi- and multilaterals, funds and
foundations, civil society organizations and private
sector – to attain their health objectives and support
their national health policies and strategies.
How we are governed?
The World Health Assembly is attended by delegations
from all Member States, and determines the policies of
the Organization.
Who we work with?
We support Member States as they coordinate the
efforts of multiple sectors of the government and
partners – including bi- and multilaterals, funds and
foundations, civil society organizations and private
sector – to attain their health objectives and support
their national health policies and strategies.
Millennium Development Goals (MDGs)
On September 6 to 8, 2000, world leaders on UN
General Assembly participate in Millennium Summit.
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 targets
corresponding to health-related MDG’s 4,5, and 6:
MDG 4 reduce child mortality
Garantisadong pambata, nutrition program ,EPI, DOH
under 5 program, EINC, IMCI
MDG 5 improve maternal health
Maternal and child care e.g. Free prenatal check up,
Maternal immunization of tetanus toxoid, laboratory /
diagnostic test e.g. U/S, Nutrition program for mother,
Family planning’ child care, pre/post partum care,
Mental health, Health teaching
MDG 6 combat HIV/ AIDS, MALARIA and other diseases.
Free testing HIV
Millennium Development Goals (MDGs)
1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education.
3. Promote gender equality and empower women.
4. Reduce child mortality.
-Target: reduce by 2/3, between 1990 and 2015, the
under-five mortality rate.
5. Improve maternal health.
-Target:
>Reduce by three quarters the maternal mortality ratio
>Achieve universal access to reproductive health
6. Combat HIV/AIDS, malaria and other diseases.
Targets:
>Have halted by 2015 and begun to reverse the spread
of HIV/AIDS
>Achieve by 2010, universal access to treatment for all
those who need it
>Have halted by 2015, and begun to reverse the
incidence of malaria and other major diseases.
7. Ensure environmental sustainability
8. Develop a global partnership for development
Sustainable Development Goals (MDGs)
• The United Nations Sustainable Development
Goals (UN SDGs, also known as the Global
Goals) are 17 goals with 169 targets that all UN
Member States have agreed to work towards
achieving by the year 2030.
• They set out a vision for a world free from
poverty, hunger and disease.
• Health has a central place in SDG 3 “Ensure
healthy lives and promote well-being for all at
all ages”, underpinned by 13 targets that cover
a wide spectrum of WHO’s work.
• Almost all of the other 16 goals are related to
health or their achievement will contribute to
health indirectly.
• The SDGs aim to be relevant to all countries –
poor, rich and middle-income – to promote
prosperity while protecting the environment
and tackling climate change. They have a strong
focus on improving equity to meet the needs of
women, children and disadvantaged
 populations in particular so that “no one is left
behind”.
• This agenda builds on the Millennium
Development Goals (MDGs) which were 8 goals
that UN Member States signed in September
2000 to achieve targets to combat poverty,
hunger, disease, illiteracy, environmental
degradation and discrimination against women
by 2015.  provincial health officers. A 2 yr program consisting of
Department of Health
 The Department of Health (DOH) holds the
over-all technical authority on health as it is a
national health policy-maker and regulatory
institution.
Mission
 To lead the country in the development of a
productive, resilient, equitable and people-
centered health system
Vision
 Filipinos are among the healthiest people in
Southeast Asia by 2022, and Asia by 2040
Roles in the Health Sector
(1) leadership in health;
(2) enabler and capacity builder; and
(3) administrator of specific services
Mandate
 To develop national plans, technical standards,
and guidelines on health
Records of public health services in the Philippines date
back to the Spanish regime. In 1557, Franciscan Friar
Juan Clemente opened a medical dispensary in
intramuros ( the old walled city of Manila) for the
indigent.
In 1690- Dominican father Juan de Pergero worked
toward installing a water system in san Juan del Norte
(Now san Juan City, MM) and Smallpox Vaccination was
introduced by Dr. Francisco de Balmis, THE PERSONAL
PHYSICIAN OF KING CARLOS IV, were appointed by the
Spanish Gov’t Who came to the phil. In 1805
The first Medicos Titilares were appointed by the
Spanish gov’t in 1876. The medicos Titulares worked as
fundamental medical and dental courses was offered in
UST in 1888. Graduates of this program known as
Cirujanos Ministrates served as male nurses and
sanitation inspectors.
In 1901 The US Phil. Commission through the ACT 57
created the Board of Health in the Phil. As the chief
executive officer eventually evolved into what is now
the Dept. of HEALTH
IN 1915 The PGH began to extend Public health Nursing
services in the home of the patients by organizing a unit
called SOCIAL HOME CARE SERVICES.
IN 1947, THE D0H was recognized into Bereaus,
quarantine, hospitals that took charged of the municipal
and charity clinics.
IN 1954, Congress passed RA 1082 or the RURAL
HEALTH ACT that provide for the creation of rural health
units in every municipality. RA 1082 provided for the
employment of physician to serve as municipal health
officer, public health nurses, midwives and sanitation
inspector and public health dentist in these facilities.
IN 1970’s The PHILIPPINE HEALTH CARE DELIVERY
SYSTEM was restructured, paving the way for the
health care delivery system that exist to this day where
health services were classified into PRIMARY,
SECONDARY AND TERTIARY LEVELS
EX: PRIMARY are municipal health office. Rural health
units, health centers, Brgy. Health stations.
SECONDARY are Provincial health office, District
hosp., emergency hosp., Provincial hosp/Provincial
medical centers.
TERTIARY are National hosp., National Medical
centers and National Specialized Hosp., Regional Hosp./
Regional Medical Centers, Teaching and Training hosp.
To enable the local gov’t to attain their fullest
development as self reliant communities and make
them more effective partners in the attainment of
national goals RA 7160 or the LOCAL GOVERNMENT
CODE was enacted in 1991.
The law mandated devolution of basic services, to the
local government units and the establishment of a local
health board in every province or municipality.
Devolution of Health Services
1987 Philippine Constitution
 Mandated the Congress to “enact a local
government code which shall provide for a
more responsive and accountable local
government structure instituted through a
system of decentralization with effective
mechanisms of recall, initiative and referendum,
allocate among the different local government
units their powers, responsibilities, and
resources, and provide for the qualifications,
election, appointment and removal, term,
salaries, powers and functions and duties of
local officials, and all other matters relating to
the organization and operation of the local units
(Section 3, Article X).”
Republic Act No. 7160
 -Local Government Code of 1991
 -From a highly centralized system of health
service delivery with the Department of Health
(DOH) as the sole provider, the Code mandated
the devolution1 to local government units
(LGUs)2 of many of the functions previously
discharged by DOH. Health devolution or
decentralization of health services was initially
geared towards efficiency and effectiveness of
health service delivery by reallocating decision-
making capability and resources to LGUs
(Grundy et al. 2003; Galvez-Tan et al. 2010)
 The implementation of the local government
code of 1991 resulted in the devolution of
health services to local government units
(LGU's) which included among others the
provision, management and maintenance of
health services at different levels of LGUs.
 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
government.
 Devolution is one administrative category of
decentralization and typically involves legal
transfer of administrative powers to political
units. In this situation, health providers then
come under the management of non- health
managers. this is essentially a public
administration conceptualization of
decentralization.

Devolution of Health Services
Primary Health Care (PHC)
 Decentralization is a core element of the
implementation of the Primary Health Care
(PHC).
 -ensures that essential health care is “made
universally accessible to individuals and
families in the community “
Philippine Local Health System
 The Philippine’s local health systems were
established on PHC principles, which is basically
“Health in the Hands of the People”
 Health devolution has empowered LGUs and
people by allowing them to participate in policy
 and decision-making that concerns delivery and
quality of health care.
 LGUs takes great responsibility in the delivery of
basic services and in the operation of facilities in
areas that include primary health care and
hospital care/services.
 DOH assumed the role as the “national
technical authority on health.” It is expected to
“ensure the highest achievable standards of
quality health care, health promotion and
health protection” that LGUs, NGOs, private
organizations, and civil society should uphold.
The Rural health unit (RHU) commonly known as the
Health Center, is the primary level health facility in the
municipality. The focus of RHU is preventive and
promotive health services and the supervision of BHSs
under its jurisdiction.
Devolved functions of the LGU has brought basic
services closer to the people, but it has also caused
fragmentation segregation of health care delivery
system in the country.
New Classification of Hospitals and
Other Health Facilities in the Philippines
A.O. No. 2012 – 0012
Classification of Hospitals According to Functional
Capacity:
A. General Hospital
 Provides medical and surgical care to the sick
and injured and maternity care and shall have
as minimum, the following clinical services:
medicine, pediatrics, obstetrics and gynecology,
surgery and anesthesia, emergency services,
out-patient and ancillary services.
B. Specialty Hospital
 Specializes in a particular disease or condition
or in one type of patient.
Advances in health sciences and services have brought
about the development of the dfferent types of health
facilities.
the DOH issued Administrative order 2012-0012
New Classification of Hospitals and
Other Health Facilities in the Philippines
New Classification of Hospitals and
Other Health Facilities in the Philippines
A.O. No. 2012 – 0012
Classification of Hospitals According to Trauma
Capability:
Guidelines formulated by PCS
A. Trauma-Capable Facility
 A DOH licensed hospital designated as a trauma
center.
B. Trauma-Receiving Facility
 A DOH licensed hospital within the trauma
service area which receives trauma patients for
transport to the point of care or a trauma
center.
Example of trauma capability hosp.
1. Las Pinas Hospital and satellite trauma center
2. San Jose Hospital and trauma center in cavite
Classifications of General Hospitals
 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.

NEW CLASSIFICATION

● Category A. Primary Health Care Facility – a first

contact health care facility that offers basic
service including emergency services and
provision for normal deliveries.

● Without in-patient beds like health centers, out-

patient clinics, and dental clinics.

● 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) facilities.

●  

● 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
● HRH- Human Resource for Health

● GIDA -Geographically Isolated Disadvantaged

Area

● IP Indigenous People