NURSING DEPARTMENT Goal 13 Take urgent action to combat climate change and its

Course No. NCM 104 Lecture impacts

Subject: Community Health Nursing 1 Goal 14 Conserve and sustainably use the oceans, seas and marine
Yr. Level: BSN 2 resources for sustainable development
Contact Hours/ Credit Units: 2 Goal 15 Protect, restore and promote sustainable use of terrestrial
ecosystems, sustainably manage forests, combat
Module 2 desertification, and halt and reverse land degradation and
The Health Care Delivery System halt biodiversity loss
Goal 16 Promote peaceful and inclusive societies for sustainable
I. Introduction: development, provide access to justice for all and build
A Public Health Nurse does not function in a vacuum. She is a member of a team working within a system. effective, accountable and inclusive institutions at all levels
For the nurse to function effectively, she has to understand the health care delivery system wherein she is working Goal 17 Strengthen the means of implementation and revitalize the
because it influences her status and functions. She needs to properly relate with the dynamics of political and Global Partnership for Sustainable Development
organizational structure surrounding her position in the health care delivery system.
B. PHILIPPINE DEPARTMENT OF HEALTH (DOH)
II. Learning Objectives:
1. Explain how the Department of Health provides health leadership in the Philippines. The Department of Health (DOH) is the principal health agency in the Philippines. It is responsible for
2. List the 2030 Agenda for Sustainable Development. ensuring access to basic public health services to all Filipinos through the provision of quality health care and
3. Describe the Philippine health care delivery system in terms of the different levels of services. regulation of providers of health goods and services.
4. Engage in advocacy activities to influence health and social care service policies and access to services.
Mission - To lead the country in the development of a productive, resilient, equitable and people-centered health
III. Core Content of the Chapter: system

A. WORLD HEALTH ORGANIZATION (WHO) Vision - Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040

2030 AGENDA FOR SUSTAINABLE DEVELOPMENT

Roles and Functions
 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 The Department of Health, in its new roles as the national authority on health providing technical and other
meet the needs of women, children and disadvantaged populations so that “no one is left behind”. resource assistance to concerned groups as

 This agenda builds on the Millennium Development Goals (MDGs) which were 8 goals that UN Member mandated by Executive Order 102 has identified the following general functions under its three specific
States signed in September 2000 to achieve targets to combat poverty, hunger, disease, illiteracy, roles in the health sector:
environmental degradation and discrimination against women by 2015.

Goal 1 End poverty in all its forms everywhere 1. Leadership in Health

Goal 2 End hunger, achieve food security and improved nutrition
and promote sustainable agriculture  Serve as the national policy and regulatory institution from which the local government units, non-
Goal 3 Ensure healthy lives and promote well-being for all at all government organizations and other members of the health sector involved in social welfare and
ages development will anchor their thrusts and directions for health.
Goal 4 Ensure inclusive and equitable quality education and
promote lifelong learning opportunities for all  Provide leadership in the formulation, monitoring and evaluation of national health policies, plans
Goal 5 Achieve gender equality and empower all women and girls and programs. The DOH shall spearhead sectoral planning and policy formulation and assessment
Goal 6 Ensure availability and sustainable management of water at the national and regional levels.
and sanitation for all
Goal 7 Ensure access to affordable, reliable, sustainable and  Serves as advocate in the adoption of health policies, plans and programs to address national and
modern energy for all sectoral concerns.
Goal 8 Promote sustained, inclusive and sustainable economic
growth, full and productive employment and decent work 2. Enabler and Capacity Builder
for all
 Innovate new strategies in health to improve the effectiveness of health programs, initiate public
Goal 9 Build resilient infrastructure, promote inclusive and
discussion on health issues and undertaking and disseminate policy research outputs to ensure
sustainable industrialization and foster innovation
informed public participation in policy decision- making.
Goal 10 Reduce inequality within and among countries
Goal 11 Make cities and human settlements inclusive, safe, resilient
 Exercise oversight functions and monitoring and evaluation of national health plans, programs and
and sustainable
policies.
Goal 12 Ensure sustainable consumption and production patterns
  Ensure the highest achievable standards of quality health care, health promotion and health
protection. Guiding principles in developing the Inter- Local Health System

1. Financial and administrative autonomy of the provincial and municipal administrations

3. Administrator of Specific Services 2. Strong political support
3. Strategic synergies and partnerships
 Manage selected national health facilities and hospitals with modern and advanced facilities that 4. Community participation
shall serve as national referral centers; and, selected health facilities at sub- national levels that are 5. Equity of access to health services by the population
referral centers for local health systems. 6. Affordability of health services
7. Appropriateness of health programs
 Administer direct services for emergent health concerns that require new complicated technologies 8. Decentralized management
that it deems necessary for public welfare; administer special components of specific programs as 9. Sustainability of health initiatives
it will benefit and affect large segments of the population, 10. Upholding of standards of equality of service

 Administer health emergency response services, including referral and networking system for Composition of Inter- Local Health Zone
trauma, injuries and catastrophic events, in cases of epidemic and other widespread danger, upon
the direction of the President in consultation with concerned LGU. 1. People – the number of people may vary from zone to zone. According to WHO, the ideal population size
of a health district is between 100, 000 to 500, 000.
DOH MILESTONES (HISTORICAL BACKGROUND) - separated 2. Boundaries – clear boundaries between Inter- Local Health Zones determine the accountability and
responsibility of health service providers, geographical locations and access to referral facilities are the
usual basic in forming boundaries.
LOCAL HEALTH SYSTEM AND DEVOLUTION OF HEALTH SERVICES 3. Health Facilities – district or provincial hospitals, RHUs, BHS and other health services deciding to work
together as an integrated health system.
 A major shift took place in 1991 with the passage of the Local Government Code also known as Republic 4. Health Workers – the right unit of health providers is needed to deliver comprehensive health services.
Act 1760. 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 to facilitate health service Philippine Health Care Delivery System
delivery.
 Devolution made local government executives responsible to operate local health care services. New  Complex set of organizations interacting to provide an array of health services
centers of authority for local health services emerged.
1. Public Sector: Financed through tax- based system
Objectives: a. National: DOH
b. Local: LGUs
1. Establish local health systems for effective and efficient delivery of health care services. 2. Private Sector
2. Upgrade the health care management and service capabilities of local health facilities. a. Profit: Commercial & market oriented
3. Promote inter- LGU linkages and cost sharing schemes including local health care financing systems for b. Non- Profit: Non- commercial & service oriented
better utilization of local health resources.
4. Foster participation of the private sector, NGOs and communities in local health systems development. CLASSIFICATION OF HEALTH FACILITIES
5. Ensure the quality of health service delivery at the local level.
New Classification of Hospitals and Other Health Facilities
Inter- Local Health System Hospitals Other Health Facilities
GENERAL A. Primary Care Facility
 This system is being espoused by the DOH in order to ensure quality of health care services at the local
 Level 1 B. Custodial Care Facility
level.
 Level 2 C. Diagnostic/ Therapeutic Facility
 Level 3 (Teaching/ Training)
Expected Achievement of the Inter- Local Health System
SPECIALTY D. Specialized Out- Patient Facility
1. Universal coverage of health insurance
2. Improved quality of hospital and RHU service New Classification of General Hospitals
3. Effective referral system HOSPITALS LEVEL 1 LEVEL 2 LEVEL 3
4. Integrated planning Clinical Consulting specialists Level 1 plus all: Level 2 plus all:
5. Appropriate health information system Services for in: Medicine Pediatrics Departmentalized Teaching/ Training
6. Improved drug management system in-patients OB- GYNE Surgery Clinical Services with accredited
7. Developed human resources residency training
8. Effective leadership program in 4 major
9. Financially visible or self- sustaining hospitals clinical services
10. Integration of public health and curative hospital care ER & OPD Services Respiratory Unit Physical Medicine
11. Strengthened cooperation between LGU and health sectors Isolation Facilities General ICU and Rehabilitation
 Unit
Dental Clinic NICU Dialysis Clinic Persistent inequities in health outcomes
Ancillary Secondary Clinical Tertiary Clinical Tertiary Laboratory 1. Every year, around 2000 mothers die due to pregnancy- related complications
Services Laboratory Laboratory with histopathology 2. A Filipino born to the poorest family is 3 times more likely to not reach his 5th birthday, compared
Blood Station Blood Station Blood Bank to one born to the richest family
1st level X- ray 2nd Level X- ray with 3rd level X- ray 3. Three out of 10 children are stunted
mobile unit
Pharmacy Restrictive and impoverishing healthcare costs
1. Every year, 1.5 million families are pushed to poverty due to health care expenditures
New Classification of Other Health Facilities 2. Filipinos forego or delay care due to prohibitive and unpredictable user fees or co- payments
A B C D 3. Php 4,000/ month healthcare expenses considered catastrophic for single income families
Primary Care Custodial Diagnostic/ Therapeutic Specialized OPD
Facility Care Facility Facility facility Poor quality and undignified care synonymous with public clinics and hospitals
With in- patient Psychiatric Laboratories: Dialysis Clinic 1. Long wait times
beds: Care Facility  Clinical 2. Limited autonomy to choose provider
Ambulatory
 Infirmary/ Lab/HIV Surgical Clinic 3. Less than hygienic restrooms & lacking amenities
Dispensary  Blood Service (ASC) 4. Privacy and confidentiality taken lightly
 Birthing Facilities 5. Poor record- keeping
Home  Drug Test Lab 6. Overcrowding & under- provision of care
 NB Screening
Lab Ambisyon Natin 2040
 Water Lab 1. Universal Health Coverage
2. Strengthen implementation of RPRH Law
Without beds: Drug Abuse Ionizing Machines as X- In- Vitro
3. War against drugs
 Medical Treatment ray, CT Scan, Fertilization (IVF)
4. Additional funds from PAGCOR
OPD and Mammography and Centers
clinics Rehabilitation others
 OFW Center 3 Guarantees to attain Health- related SDG Targets
clinics (DATRC)
1. All Life Stages & Triple Burden of Disease (Services for both the well & the sick)
 Dental
2. Service Delivery Network (Functional Network of Health Facilities) Networks should be:
clinics
a. Fully functional
Sanitarium/ Non- ionizing Radiation b. Compliant with clinical practice guidelines
Leprosarium Machines as Oncology Facility c. Available 24/7 & even during disasters
Ultrasound, MRI d. Practicing gatekeeping
and others e. Located close to the people
Nursing Nuclear Medicine Oncology Center/ f. Enhanced by telemedicine
Home Clinic 3. Universal Health Insurance (Financial Freedom when Accessing Services)
Services are financed predominantly by PhilHealth
a. PhilHealth as the gateway to free affordable care
PHILIPPINE HEALTH AGENDA (2016- 2022)  100% of Filipinos are members
 Formal sector premium paid through payroll
Health Agenda: All for Health towards Health for All  Non- formal sector premium paid through tax subsidy
b. Simplify PhilHealth Rules
(Lahat Para sa Kalusugan Tungo sa Kalusugan Para sa Lahat!)  No balance billing for poor/ basic accommodation & Fixed co¬payment for non-
basic accommodation
Goals: c. PhilHealth as main revenue source for public health care providers
1. Financial protection  Expand benefits to cover comprehensive range of services
2. Better health outcomes  Contracting networks of providers within SDNs
3. Responsiveness
Strategy- A. C. H. I. E. V. E.
Values:
1. Equitable & inclusive to all A – Advance quality, health promotion and primary care
2. Transparent & accountable 1. Conduct annual health visits for all poor families and special populations (NHTS, IP, PWD, Senior
3. Uses resources efficiently Citizens)
4. Provides high quality services 2. Develop an explicit list of primary care entitlements that will become the basis for licensing and
contracting arrangements
 3. Transform select DOH hospitals into mega-hospitals with capabilities for multi-specialty training IV. Activity:
and teaching and reference laboratory
4. Support LGUs in advancing pro-health resolutions or ordinances (e.g. city-wide smoke-free or 1. Research on the current PhilHealth data coverage and benefits package and take note of the community health
speed limit ordinances) services covered by PhilHealth. Give at least 3 scenarios wherein you may use this information.
5. Establish expert bodies for health promotion and surveillance and response
V. Bibliography:
C – Cover all Filipinos against health-related financial risk
1. Raise more revenues for health, e.g. impose health promoting taxes, increase NHIP premium rates, Cuevas, F. (2007). Public health nursing in the Philippines. Publications Committee National League of Philippine
improve premium collection efficiency. Government Nurses, Inc.
2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with PhilHealth Famorca, Z., Nies, M., & McEwen, M. (2013). Nursing care of the community: A comprehensive text on community
3. Expand PhilHealth benefits to cover outpatient diagnostics, medicines, blood and blood products and public health nursing in the Philippines. Elsevier (Singapore) Pte Ltd.
aided by health technology assessment Rules and regulations governing the new classification of hospitals and other health facilities in the Philippines.
5. Update costing of current PhilHealth case rates to ensure that it covers full cost of care and link (2012). Department of Health.
payment to service quality UN General Assembly (2015) Transforming our world: the 2030 Agenda for Sustainable Development. United
6. Enhance and enforce PhilHealth contracting policies for better viability and sustainability Nations.
Department of Health (2018). Philippine Health Agenda 2016- 2022. Manila, Philippines: Department of Health.
H – Harness the power of strategic HRH development
1. Revise health professions curriculum to be more primary care-oriented and responsive to local
and global needs
2. Streamline HRH compensation package to incentivize service in high-risk or GIDA areas
3. Update frontline staffing complement standards from profession-based to competency-based
4. Make available fully funded scholarships for HRH hailing from GIDA areas or IP groups
5. Formulate mechanisms for mandatory return of service schemes for all heath graduates

I – Invest in eHealth and data for decision making

1. Mandate the use of electronic medical records in all health facilities
2. Make online submission of clinical, drug dispensing, administrative and financial records a
prerequisite for registration, licensing and contracting
3. Commission nationwide surveys, streamline information systems, and support efforts to improve
local civil registration and vital statistics
4. Automate major business processes and invest in warehousing and business intelligence tools
5. Facilitate ease of access of researchers to available data

E – Enforce standards, accountability and transparency

1. Publish health information that can trigger better performance and accountability
2. Set up dedicated performance monitoring unit to track performance or progress of reforms

V – Value clients and patients, especially the poor, marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all health programs and support them in non-direct
health expenditures
2. Make all health entitlements simple, explicit and widely published to facilitate understanding, &
generate demand
3. Set up participation and redress mechanisms
4. Reduce turnaround time and improve transparency of processes at all DOH health facilities
5. Eliminate queuing, guarantee decent accommodation and clean restrooms in all government
hospitals

E – Elicit multi- sectoral and multi- stakeholder support for health

1. Harness and align the private sector in planning supply side investments
2. Work with other national government agencies to address social determinants of health
3. Make health impact assessment and public health management plan a prerequisite for initiating
large-scale, high-risk infrastructure projects
4. Collaborate with CSOs and other stakeholders on budget development, monitoring and evaluation