Health Care Delivery

System (Part 1)
John Carlo L. Divina, MSN, RN, CDPO, CHA, FRIN
Assistant Professor
Contents

01 The Context

02 Primary Health Care

03 Sustainable Development Goals

04 World Health Organization

05 Department of Health
 01
The Context
Definition of Terms, Functions of Health Systems, WHO 6 Building Blocks, Health Situation in the
Philippines, Determinants of Health & Philippine Health Care Delivery System
Definition of Terms

Health Systems
- comprises all organizations,
institutions and resources that
produce actions whose primary
purpose is to improve health (World
Health Organization, 2000).
 Definition of Terms

Health Care Delivery

System
- A mechanism for
providing services that
meet the health-related
needs of the individuals.
4 Essential Functions of Health System

 Service provision

 Resource generation

 Financing

 Stewardship
The Context of the Philippine Health Care System

 Health is a basic human right .

 The Department of Health is the lead health agency.

 Local Government Code (RA 7160) sets devolution.

 Mandanas-Garcia Supreme Court Ruling increased

the allocation of internal revenue allotment to LGUs &
EO No. 138, series 2021 supported this.
Determinants of Health

 Income & Social Status

 Education
 Physical Environment
 Employment & Working Conditions
 Social Support Networks
 Culture
 Genetics
 Personal Behaviors & Coping Skills
 Health Services
 Gender
The Context of the Philippine Health Care System

Access to health is hampered by:

 High Cost

 Physical and socio-cultural barriers

 Health workforce crisis

Health Care System Models

1. Private Enterprise Health Care Model

2. Social Security Health Model

3. Publicly Funded Health Model

4. Social Health Insurance Model

Philippine Health Care Delivery System
 02
Primary Health Care
Definition, Alma Ata Declaration, Declaration of Astana,
Key Principles
Primary Health Care

● Essential health care

● Practical, scientifically sound and socially
acceptable methods and technology
● Universally accessible to individuals and
families in the community
● Full participation and at a cost the
community and country can afford to
maintain
● In the spirit of self-reliance and self-
determination
Alma Ata Declaration on PHC (September 6-12, 1978)

1. Health is a basic fundamental right

2. Global burden of health inequalities among
populations
3. Economic & social development is of basic
importance for full attainment of health for all
4. Governments have a responsibility for the
health of their people

(LOI 949 of 1979) – PH as 1st country in Asia

5 Key Elements to Achieve the Goal of Health for
All:
1. Reducing exclusion & social disparities (UHC)
2. Organizing health services around people’s needs
and expectations (Health Service Reforms)
3. Integrating health into all sectors (Public Policy
Reforms)
4. Pursuing collaborative models of policy dialogue
(Leadership Reforms)
5. Increasing stakeholder participation
8 Essential Services of the Alma Ata Declaration
Declaration of Astana
Declaration of Astana
1. We strongly affirm our commitment to the fundamental right
of every human being to the enjoyment of the highest
attainable standard of health without distinction of any kind.
2. We are convinced that strengthening primary health care
(PHC) is the most inclusive, effective and efficient approach
to enhance people’s physical and mental health, as well as
social well-being, and that PHC is a cornerstone of a
sustainable health system for universal health coverage
(UHC) and health-related SDGs.
3. We acknowledge that in spite of remarkable progress over
the last 40 years, people in all parts of the world still have
unaddressed health needs.
4 Commitments of the Declaration of Astana

1. Make bold political choices for health across all

sectors

2. Build sustainable primary health care

3. Empower individuals and communities

4. Align stakeholder support to national policies,

strategies and plans.
The Success of PHC is driven by:

 Knowledge and capacity building – scientific & traditional

knowledge, research & access for all

 Human resources for health – decent work & compensation, invest in

education & training, retention & availability in rural areas

 Technology - quality, safe, effective and affordable medicines, including, as

appropriate, traditional medicines, vaccines, diagnostics and other technologies;
information systems

 Financing – financial sustainability

Key Principles of PHC

 4 A’s: Accessibility, Affordability, Acceptability

and Availability
 Support Mechanism
 Multi-sectoral Approach
 Community Participation
 Equitable Distribution of Health Resources
 Appropriate Technology
1. 4 A’s of PHC

• Accessibility – physical distance or travel time, 30 minutes;

BHS
• Affordability – individual, community and country’s capacity
to pay, out-of-pocket expenses
• Acceptability – cultural and traditional perspective
• Availability – offered in regular and organized manner
2. Support Mechanism
Essential services:

• People

• Government

• Private Sector
3. Multisectoral Approach

• Intrasectoral –within health

sector

• Intersectoral – encompassing
other sectors aside from health;
synergistic effect
4. Community Participation

• Health is achieved through sel-resilience & self-

determination.
• Communities as active participants of health
care.
5. Equitable Distribution of Health

• Geographically Isolated & Disadvantaged

Areas (GIDA) – marginalized population physically & socio-
economically separated from society.

• Human Resources for Health - Doctors to the Barrios

(DTTB), Nurse Deployment Program, Medical Technologist
Deployment Program
6. Appropriate Technology
Criteria:
• Safety – DPT not given > 7 yo
• Effectiveness – achieving its purpose; 10 Herbal Medicines
• Affordability – low cost
• Simplicity – ORESOL use
• Acceptability – culture-based
• Feasibility & Reliability – DSSM vs CXR
• Ecological Effects – no mercury based thermometers
• Potential Contribution – self-sufficiency
Primary Health Care vs Primary Care
Parameters Primary Health Care Primary Care

Focus client Family & Community Individual

Focus of care Promotive & preventive Curative provided by
through community health professionals
participation
Decision-making Community centered/ Health worker driven
process consultative-participative
Outcome Self-reliance / self-help Reliance on health
professionals to
restore / regain health
Setting for services Rural-based satellite Mostly urban-based:
clinics, community health hospitals & clinics
PHC Contributions

1. Training of Health Workers

3 Levels of Training:
 Grassroot/ Village – BHWs/ BNS/ Volunteers
 Intermediate – Public Health Workers
 First line - Specialists
PHC Contributions

2. Botika ng Barangay

RA 6675 – Generics Act of 1998 (Dr. Alfredo Bengzon)

PHC Contributions

3. Homemade ORESOL
PHC Contributions

4. Herbal
Medications
PHC Contributions

RA 8423
 03
The Sustainable Development Goals
Health-Related SDG, Targets & Indicators
Global & Country Health Imperatives

 Shifts in demographic and epidemiological trends in

disease, including the emergence and re-emergence of
new diseases
 New technologies for health care, communication and
information
 Existing and emerging environmental hazards some
associated with globalization
 Health reforms
Sustainable Development Goals (The Global Goals)

The 2030 Agenda for Sustainable

Development, adopted by all
United Nations Member States in
2015, provides a shared blueprint
for peace and prosperity for
people and the planet, now and
into the future.
Learning Materials
Brief Explanation on
SDG No. 3 SDG No. 3 Report 2021

https://youtu.be/HN9Gz7rCF https://youtu.be/J5wZiVd-x4g
o4
 04
The World Health Organization
History, Governance, Objective, Core Functions & Activities
World Health Organization

● April 7, 1948
● Geneva, Switzerland
● 148 country offices
● 6 regional offices (AFRO, AMRO,
EMRO, EURO, SEARO, WPRO)
Governance

• The World Health Assembly is the WHO’s supreme decision-

making body and consists of 194 Member States.

• The Executive Board is composed of 34 members technically

qualified in the field of health, with members being elected for three-
year terms. The Board chairman’s post is held by rotation for one
year by each of the WHO’s six regional groups

• The Secretariat consists of the Director General, 5 Assistant

Director Generals and 8,000 health experts/ staff across 6 regional
offices.

• WHO’s emergency work is governed by a legal framework known as

the International Health Regulations.
Dr. Patrick Amoth Dr. Tedros Adhanom Ghebreyesus
Chair, Executive Board Director General
Objective:
Attainment by all peoples of the highest possible level of health
 05
Department of Health - Philippines
Vision, Mission, Roles, Values, Milestones, Structure & Calendar of Activities
Department of Health

● September 10, 1898

● San Lazaro Compound, Tayuman, Sta.

Cruz, Manila

● Dr. Jose Fabella– 1st Filipino Health

Secretary

● Dr. Francisco Duque III – current Health

Secretary
Department of Health
• holds the over-all technical authority on health as it is a
national health policy-maker and regulatory institution.

Vision
Filipinos are among the healthiest people in Southeast
Asia by 2022, and Asia by 2040

Mission
To lead the country in the development of a productive,
resilient, equitable and people-centered health system
3 Major Roles in the Health Sector

1. Leadership in health

2. Enabler and capacity builder

3. Administrator of specific services

1. Leadership Role

• Planning and formulating policies of health programs &

services
• Monitoring & evaluating the implementation of health
programs, projects, research & training and services
• Advocating for health promotion & healthy lifestyles
• Serving as technical authority in disease control &
prevention
• Providing administrative and technical leadership in
health care financing and implementation the National
Health Insurance Law
2. Enabler & Capacity Builder

• Providing logistical support to LGUs , the private sector,

and other agencies in implementing health programs
and services
• Serving as the lead agency in health & medical research
• Protecting standards of excellence in the training and
education of health care providers at all levels of the
health care system.
3. Administrator of Specific Services

• Serve as administrator of specific selected health facilities at

subnational levels that act as referral centers for local health
systems (tertiary and specialty hospitals, reference laboratories, training
centers, regulatory offices.
• Provide specific program components for conditions that
affect large segments of the population such as TB,
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.
Values:

• Integrity
• Excellence
• Compassion and respect for human dignity
• Commitment
• Professionalism
• Teamwork
• Stewardship of the health of the people
Office of the Chief of Staff
Line Agency or DOH Programs / Attached Agency
Unit Divisions/ Units
Legal service Integrity Management Corporate Hospitals:
Committee; • Philippine Heart
Human Rights Center
• National Kidney
Transplant Institute
• Lung Center of the
Philippines
• Philippine Children
Medical Center
Internal Service Audit
Media Relations Unit
Functional Management Team

1. Administration & Financial Management

2. Health Policy & Systems Development
3. Public Health Services
4. Health Facilities & Infrastructure Development
5. Health Regulation
6. Procurement & Supply Chain Management
7. Field Implementation & Coordination
1. Administration & Financial Management Team
Line Agency or DOH Unit Programs / Divisions/
Units
Financial & Management Service

Administrative Service Personnel Administration Division

including Performance Based
Bonus

Public Assistance Unit &

Complaints Hotline
2. Health Policy & Systems Development Team
Line Agency or DOH Unit Programs / Divisions/ Attached Agency
Units
Health Policy Development Office for Strategic Philippine Health Insurance
& Planning Bureau Management Corporation
Bureau of Local Health Participatory Governance
Systems and Development
Bureau of International Migrant Health
Health Cooperation
Health Human Resource
Development Bureau
3. Public Health Services Team
Line Agency or DOH Unit Programs / Divisions/ Attached Agency
Units
Disease Prevention and National Voluntary Blood Philippine National AIDS
Control Bureau Services Program and Council
Epidemiology Bureau Organ Donation Program
National Nutrition Council
Health Promotion &
Communication Service
Population Commission –
re-integrated to NEDA &
Health Emergency
renamed to Commission on
Management Bureau
Population & Development
as per EO No. 71 as of
December 2020.
4. Health Facilities & Infrastructure Development Team
Line Agency or DOH Unit Programs / Divisions/ Units

Health Facilities Development Bureau Public-Private Partnership

Medical Tourism

Knowledge Management and National Data Privacy & Freedom of

Information Technology Service Information

Dangerous Drugs Abuse Prevention &

Treatment Program

Health Facilities Enhancement

Program
5. Health Regulation Team
Line Agency or DOH Unit
Food & Drug Administration
Health Facilities Services &
Regulatory Bureau
Bureau of Quarantine
Programs / Divisions/ Attached Agency
Units
Philippine Institute of
Traditional and Alternative
Health Care
Committee of Examiners for
Massage Therapists;
Committee of Examiners for
Undertakers & Embalmers
Pharmaceutical Division
6. Procurement & Supply Chain Management Team

Line Agency or DOH Unit

Procurement Service

Logistics Management Division

7. Field Implementation & Coordination Team
Cluster Line Agency or DOH Unit
Luzon Center for Health Developments (CHDs)
• Regional Hospitals
• Drug Abuse Treatment &
Rehabilitation Centers (DATRC)
NCR & Metro Manila Hospitals CHDs
• Regional Hospitals
• DATRC
• Metro Manila Hospitals
Visayas-Mindanao CHDs
• Regional Hospitals
• DATRC
• DOH ARMM
Center for Health Developments
• Responsible for field operations of the Departments in its administrative
region and for providing catchment area with efficient and effective medical
services.
• Tasked to implement laws, regulations, policies & programs.
• Tasked to coordinate with regional offices of the other Departments, offices
and agencies as well as with the local government units.
• Act as main catalyst and organizer of the ILHZ
• Provide technical support & advocacy for the development of local health
management systems and their integration in the context of the ILHZ
• Review and approve ILHZ proposals for funding.
• Integrate local health plans into regional plans
• Undertake monitoring of the development and implementation of ILHZ.
DOH Hospitals
 Provides hospital- based care or
general services