HEALTH CARE

DELIVERY SYSTEM
Ralph Rigor M. Canlapan, RN
Instructor, Dept.of Nursing and Midwifery
College of Our Lady of Mt. Carmel (P)
THE WORLD HEALTH ORGANIZATION
● When diplomats formed the UN in 1945, they also discussed the
creation of a global health organization. The World Health
Organization (WHO) was the outcome of these discussions.
● The WHO constitution came into force on April 7, 1948. Since then,
April 7 has been celebrated each year as World Health Day (WHO,
2013).
● 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, 2007).
THE WORLD HEALTH ORGANIZATION
● The WHO constitution states that its objective is the attainment by all peoples
of the highest possible level of health (WHO, 2006). To attain its objective,
WHO carries out the following core functions (WHO: 2013):
○ Providing leadership on matters critical to health and engaging in
partnerships where joint action is needed.
○ Shaping the research agenda and stimulating the generation, translation,
and disseminating valuable knowledge. The WHO strategy on research
for health has five goals (WHO, 2013):
■ 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;
THE WORLD HEALTH ORGANIZATION
■ 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; and
■ 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
implementation.
● Articulating ethical and evidence-based policy options.
● Providing technical support, catalyzing change, and building sustainable
institutional capacity.
 THE MILLENNIUM
DEVELOPMENT GOALS
THE MILLENNIUM DEVELOPMENT GOALS
● On September 6 to 8, 2000, world leaders in the UN General Assembly
participated in the Millennium Summit. The result of the Summit was a
resolution entitled United Nations Millennium Declaration (UN, 2013).
○ In this declaration, the world leaders recognized their collective
responsibility to uphold the principles of human dignity, equality, and
equity at the global level. To uphold these principles is their duty to all the
people of the world, especially the most vulnerable and, in particular, the
children (UN General Assembly, 2000).
○ 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 (MDGs)--
by the year 2015 (UN, 2013).
Eight Millennium Development Goals
(MDGs)
● Eradicate extreme poverty and hunger
● Achieve universal primary education
● Promote gender equality and empower women
● Reduce child mortality.
○ Target: reduce by two-thirds, between 1990 and 2015, the under-
five mortality rate.
● Improve maternal health.
○ Targets:
■ Reduce by three quarters the maternal mortality ratio; and
■ Achieve universal access to reproductive health.
Eight Millennium Development Goals
(MDGs)
● 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
HIV/AIDS for all those who need it; and
■ Have halted by 2015 and begun to reverse the incidence of
malaria and other major diseases.
● Ensure environmental sustainability.
● Develop a global partnership for development.
THE PHILIPPINE HEALTH
CARE DELIVERY SYSTEM
Ralph Rigor M. Canlapan, RN
Instructor, Dept.of Nursing and Midwifery
College of Our Lady of Mt. Carmel (P)
THE PHILIPPINE HEALTH CARE DELIVERY
SYSTEM
● 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 governments are responsible for administration of
provincial and district 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
(BI-ISs) provide health services in the periphery of the municipality or
city.
THE PHILIPPINE HEALTH CARE DELIVERY
SYSTEM
● 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
municipal/city government, higher levels of services may
be provided
THE PHILIPPINE HEALTH CARE DELIVERY
SYSTEM
● The private sector is composed of for-profit and nonprofit
agencies.
○ 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 sector.
○ This sector also employs more than 7000 of the health
professionals in the Philippines (Romualdez, 2011).
THE PHILIPPINE HEALTH CARE DELIVERY
SYSTEM
● Financing of health services is provided by three major groups:
the government (national and local), private sources, and
social health insurance.
● The National Health Insurance Act of 1995 (RA. 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 citizens (Congress of the
Republic of the Philippines, 1995)
THE DEPARTMENT OF HEALTH

● The Department of Health (DOH) is the

national agency mandated to lead the
health sector towards assuring quality
health care for all Filipinos.
THE DEPARTMENT OF HEALT
Mission
Guarantee equitable,
sustainable, and quality health
for all Filipinos, especially the
poor, and to lead the quest for
excellence in health
Vision
To be a global leader for
attaining better health outcomes,
competitive and responsive
health care system, and
equitable health financing.
THE DEPARTMENT OF HEALTH

● In the pursuit of its vision and execution of its mission, the DOH has the
following major roles:
○ leader in health
○ enabler and capacity builder, and
○ administrator of specific services (DOH, 2013)
● The leadership role of the DOH is specifically explained 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; and
○ Providing administrative and technical leadership in health care financing
and implementing the National Health Insurance Law.
THE DEPARTMENT OF HEALTH

● As enabler and capacity builder, the DOH performs the

following functions (Office of the President, 1999):
○ Providing logistical 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; and
○ Protecting standards of excellence in the training and
education of health care providers at all levels of the health
care system
THE DEPARTMENT OF HEALTH

● As administrator of specific services, the DOH is tasked to (Office of the

President, 1999):
○ Serve as administrator of selected health 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 tuberculosis, malaria,
schistosomiasis, HIV/AIDS, and micronutrient deficiencies;
○ Develop strategies for responding to emerging health needs; and
○ Provide leadership in health emergency preparedness and response
services, including referral and networking systems for trauma, injuries,
and catastrophic events.
DOH Core Values
● integrity,
● excellence,
● compassion and respect for human dignity,
● commitment,
● professionalism,
● teamwork, and
● stewardship of the health of the people (DOH,
2013b).
THE DEPARTMENT OF HEALTH

● The DOH carries out its work through the various central
bureaus and services in the Central Office, Centers for Health
Development (CHD) in every region, DOH attached agencies,
and DOH-retained hospitals (see Figure 9.1 for the
organizational chart of the Philippine DOH)
LEVELS OF HEALTH CARE DELIVERY

● DOH Administrative Order 2012-0012 classifies other health

facilities as follows:
○ Category A. Primary care facility- a first-contact health
care facility that offers basic services 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. Examples are infirmaries and
birthing (lying-in) facilities.
LEVELS OF HEALTH CARE DELIVERY

● DOH Administrative Order 2012-0012 classifies other health

facilities as follows:
○ 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.
○ Examples are custodial psychiatric facilities, substance
drug abuse treatment and rehabilitation centers,
sanitaria/leprosaria, and nursing homes.
LEVELS OF HEALTH CARE DELIVERY

● DOH Administrative Order 2012-0012 classifies other health

facilities as follows:
○ 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 water analysis. The test
covers the pre-analytical, analytical, and post-analytical
phases of examination. This category is further classified
into:
■ Laboratory facility, such as, but not limited to the
following:
LEVELS OF HEALTH CARE DELIVERY

■ Laboratory facility, such as, but not limited to the following:

● Clinical laboratory
● HIV testing laboratory
● Blood service facility
● Drug testing laboratory
● Newborn screening laboratory
● Laboratory for drinking water analysis
■ Radiologic facility providing services such as X-ray, CI scan, mammography,
MRI, and ultrasonography.
■ 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
LEVELS OF HEALTH CARE DELIVERY

● DOH Administrative Order 2012-0012 classifies other health

facilities as follows:
○ 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
The Rural Health Unit
● The Rural Health Unit (RHU), commonly known as a health
center, is a primary level health facility in the municipality
● The focus of the RHU is preventive and promotive health
services and the supervision of BHSs under its jurisdiction
(DOH, 2001).
● The recommended ratio of RHU to catchment population is 1
RHU:20,000 population (DOH, 2009).
● The BHS is the first-contact health care facility that offers basic
services at the barangay level. It is a satellite station of the
RHU (DOH, 2009). It is manned by volunteer Barangay Health
workers (BHWs) under the supervision of the Rural Health
Midwife (RHM) (DOH, 2001).
The Rural Health Unit Personnel
● The Municipal Health Officer (MHO) or Rural Health Physician heads
the health services at the municipal level and carries out the following
roles and functions:
○ Administrator of the RHU
■ Prepares the municipal health plan and budget
■ Monitors the implementation of basic health services
■ Management of the RHU staff
○ Community physician
■ Conducts epidemiological studies
■ Formulates health education campaigns on disease
prevention
■ Prepares and implements control measures or rehabilitation
plans
The Rural Health Unit Personnel
● The Municipal Health Officer (MHO) or Rural Health Physician heads
the health services at the municipal level and carries out the following
roles and functions:
○ Medico-legal officer of the municipality (DOH, 2001)

Note: The revised implementing rules and regulations (IRRS) of RA.

7305 or the Magna Carta of Public Health Workers stipulate that there be
one (1) rural health physician to a population of 20,000 (DOH, 1999).
The Public Health Nurse (PHN)
● Supervises and guides all RHMs in the municipality (DOH, 2001);
● Prepares the FHSIS (Field Health Services Information System)
quarterly and annual reports of the municipality for submission to the
Provincial Health Office (DOHIMS, 2011);
● Utilizes the nursing process in responding to health care needs,
including needs for health education and promotions, of individuals,
families, and catchment community; and
● Collaborates with the other health team, government agencies,
private businesses, NGOs, and people’s organizations to address the
community’s health problems.

Note: RA. 7305 IRRs provide for the same nurse population ratio as
that of the Rural Health Physician, that is, 1:20,000 (DOH, 1999).
The Public Health Nurse (PHN)
● With a recommended ratio of 1 for every 5,000 population (DOH,
2009), the RH Midwife:
○ Manages the BHS and supervises and trains the BHW;
○ Provides midwifery services and executes health care programs
and activities for women of reproductive age, including family
planning counseling and services;
○ Conducts patient assessment and diagnosis for referral or further
management;
○ Performs health information, education, and communication
activities;
○ Organizes the community; and
○ Facilitates barangay health planning and other community health
services (DOH, 2001).
Rural Sanitation Inspector
● are directed towards ensuring a healthy physical
environment in the municipality. This entails
advocacy, monitoring, and regulatory activities, such
as inspection of water supply and unhygienic
household conditions (DOH, 2001).
Barangay Health Workers (BHWs)
● are considered as the interface between the
community and the RHU.
● They are trained in preventive health care, with a
strong emphasis on maternal and child care, family
planning and reproductive health, nutrition, and
sanitation.
● They are also equipped with basic skills for
prevention and management of common diseases.
● They assist in providing basic services at the BHS
and the RHU (DOH, 2001).
Barangay Health Workers (BHWs)
● BHWs are accredited by the local health board
according to DOH guidelines.
● Although they carry the status of volunteers, RA.
7883 or the Barangay Health Workers’ Benefit and
Incentives Act entitles them to hazard and
subsistence allowances and other benefits
(Congress of the Republic of the Philippines, 1995).
● The recommended ratio of BHW to catchment
population is 1 BHW:20 households (DOH,
2009).
THE LOCAL
HEALTH BOARDS
RA 7160 or Local Government
Code
● was enacted to bring about genuine and meaningful local
autonomy.
● This will enable local governments to attain their fullest
development as self-reliant communities and make them more
effective partners in the attainment of national goals.
● It mandates devolution of basic services from the national
government to LGUs.
○ Devolution refers to the act by which the national
government confers power and authority upon the various
LGUs to perform specific functions and responsibilities
(Congress of the Republic of the Philippines, 1991)
RA 7160 or Local Government
Code
● Provided for the creation of the Provincial Health Board and
the City/ Municipal Health Boards, or Local Health Boards.
○ The chairman of the board is the local executive-the
Provincial Governor/ Mayor.
○ The Provincial/City/Municipal Health Officer serves as vice
chairman.
○ Members of the board are composed of the chairman of
the committee on health of the Sanggunian, a
representative from the private sector or NCO involved in
health services, and a representative of the DOH
(Congress of the Republic of the Philippines, 1991).
RA 7160 or Local Government
Code
● Provided for the creation of the Provincial Health Board and
the City/ Municipal Health Boards, or Local Health Boards.
○ The chairman of the board is the local executive-the
Provincial Governor/ Mayor.
○ The Provincial/City/Municipal Health Officer serves as vice
chairman.
○ Members of the board are composed of the chairman of
the committee on health of the Sanggunian, a
representative from the private sector or NCO involved in
health services, and a representative of the DOH
(Congress of the Republic of the Philippines, 1991).
Functions of Local Health Boards

● Proposing to the Sanggunian annual budgetary

allocations for the operation and maintenance of
health facilities and services within the province/city/
municipality;
● Serving as an advisory committee to the
Sanggunian on health matters; and
● Creating committees that shall advise local health
agencies on various matters related to health
service operations.
THE HEALTH REFERRAL SYSTEM
● Implemented since 1992, devolution has brought decision making and
accountability on basic government services closer to the people.
This has allowed local leaders to have a greater hand in the future of
communities. However, it has brought about fragmentation of the
health care delivery system in the Philippines. It resulted in a three-
level system where local and national governments are responsible
for independent services. Also, municipalities/cities began operating
separately from each other causing further segregation of public
health services (DOH, 2001).
THE HEALTH REFERRAL SYSTEM
● A referral is a set of activities undertaken by a health care provider or facility in
response to its inability to provide the necessary health intervention to satisfy a
patient’s need
○ A functional referral system is one that ensures the continuity and
complementation of health and medical services. It is comprehensive,
encompassing promotive, preventive, curative. and rehabilitative care.
● It engages all health facilities from the lowest to the highest level. It usually
involves movement of a patient from the health center of first contact and
the hospital at first referral level. When hospital intervention has been
completed, the patient is referred back to the health center.
○ This accounts for the term two-way referral system (DOH, 2001).
THE HEALTH REFERRAL SYSTEM
● Referrals may be internal or external.
○ Internal referrals occur within the health facility, from one health
personnel to another. An internal referral maybe made to request for an
Opinion or suggestion, comanagement, or further management or
specialty care (DOH, 2001).
○ External referral is a movement of a patient from one health facility to
another. It may be vertical, where the patient referral may be from a lower
to a higher level of health facility or the other way round. The referral may
also be horizontal, where the patient is referred between similar facilities
in different catchment areas.
THE HEALTH REFERRAL SYSTEM
● Referrals may be internal or external.
○ Internal referrals occur within the health facility, from one health
personnel to another. An internal referral maybe made to request for an
Opinion or suggestion, comanagement, or further management or
specialty care (DOH, 2001).
○ External referral is a movement of a patient from one health facility to
another. It may be vertical, where the patient referral may be from a lower
to a higher level of health facility or the other way round. The referral may
also be horizontal, where the patient is referred between similar facilities
in different catchment areas.
HEALTH SECTOR REFORM:
UNIVERSAL HEALTH CARE
● 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 health sector reforms.
● UHC was built upon the strategies of two previous platforms of reform: the
initial Health Sector Reform Agenda (1999-2004) and FOURmula One (F 1)
for Health (2005-2010). UHC is planned for implementation until 2016 (DOH,
2010).
● Goals and Objectives:
○ better health outcomes
○ sustained health financing, and
○ a responsive health system by ensuring that all Filipinos, especially the
disadvantaged group, have equitable access to affordable health care
(DOH, 2010).
Strategic thrusts
● The attainment of the goal of UHC is through the pursuit of three strategic
thrusts:
○ Financial risk protection through expansion in NHIP (National Health
Insurance Program) enrollment and benefit delivery
○ Improved access to quality hospitals and health care facilities
○ Attainment of the health-related MDGs (DOH, 2010)
SIX STRATEGIC INSTRUMENTS
● To achieve the three strategic thrusts, SIX STRATEGIC INSTRUMENTS shall
be optimized:
○ 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 transform the health service delivery
structure to address variations in health service utilization and health
outcomes across socioeconomic variables.
○ Policy, standards, and regulation instrument to ensure equitable access
to health services, essential medicines, and technologies of assured
quality, availability, and safety.
○ Governance for health instrument to establish the mechanisms for
efficiency, transparency, and accountability, and prevent opportunities for
fraud.
SIX STRATEGIC INSTRUMENTS
● To achieve the three strategic thrusts, SIX STRATEGIC INSTRUMENTS shall
be optimized:
○ Human resources for health instrument to 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:
■ Provide evidence for policy and program development;
■ Support for immediate and efficient provision of health care and
management of province-wide health systems (DOH, 2010).