Saint Mary’s University

SCHOOL OF HEALTH and NATURAL SCIENCES

Nursing Department
Bayombong, Nueva Vizcaya

NURSING DEPARTMENT
Course No.: NCM 118 Lecture
Subject: FUNDAMENTALS OF NURSING PRACTICE LECTURE
Yr. Level: BSN 1C
Contact Hours/ Credit Units: 3
Prepared by: ALFER JHUN G. NVARRO

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

HEALTH CARE SYSTEM

- an organized plan of health services (Miller-Keane, 1987)

HEALTH CARE DELIVERY

- rendering health care services to the people (Williams-Tungpalan,
1981).

HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981)

- the network of health facilities and personnel which carries out the
task of rendering health care to the people.

PHILIPPINE HEALTH CARE SYSTEM

- is a complex set of organizations interacting to provide an array of
health services (Dizon, 1977).

COMPONENTS OF THE HEALTH DELIVERY SYSTEM

The Department of Health Mandate:

The Department of Health shall be responsible for the following:

formulation and development of national health policies, guidelines,
standards and manual of operations for health services and programs;
issuance of rules and regulations, licenses and accreditations;
promulgation of national health standards, goals, priorities and indicators;
development of special health programs and projects and advocacy for
legislation on health policies and programs. The primary function of the
Department of Health is the promotion, protection, preservation or
restoration of the health of the people through the provision and delivery of
health services and through the regulation and encouragement of providers
of health goods and services (E.O. No. 119, Sec. 3).

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
 Saint Mary’s University
SCHOOL OF HEALTH and NATURAL SCIENCES
Nursing Department
Bayombong, Nueva Vizcaya

Vision:

Health as a right. Health for All Filipinos by the year 2000 and Health
in the Hands of the People by the year 2020.

Mission:

The mission of the DOH, in partnership with the people to ensure

equity, quality and access to health care:

- by making services available

- by arousing community awareness
- by mobilizing resources
- by promoting the means to better health

LEVELS OF HEALTH CARE FACILITIES

1. PRIMARY LEVEL OF HEALTH CARE FACILITIES

- are the rural health units, their sub-centers, chest clinics, malaria
eradication units, and schistosomiasis control units operated by the
DOH; puericulture centers operated by League of Puericulture
Centers; tuberculosis clinics and hospitals of the Philippine
Tuberculosis Society; private clinics, clinics operated by the
Philippine Medical Association; clinics operated by large industrial
firms for their employees; community hospitals and health centers
operated by the Philippine Medicare Care Commission and other
health facilities operated by voluntary religious and civic groups
(Williams-Tungpalan, 1981).

2. SECONDARY LEVEL OF HEALTH CARE FACILITIES

- are the smaller, non-departmentalized hospitals including emergency

and regional hospitals.
- Services offered to patients with symptomatic stages of disease,
which require moderately specialized knowledge and technical
resources for adequate treatment.

3. TERTIARY LEVEL OF HEALTH CARE FACILITIES

- are the highly technological and sophisticated services offered by

medical centers and large hospitals. These are the specialized
national hospitals.
- Services rendered at this level are for clients afflicted with diseases
which seriously threaten their health and which require highly

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
 Saint Mary’s University
SCHOOL OF HEALTH and NATURAL SCIENCES
Nursing Department
Bayombong, Nueva Vizcaya

technical and specialized knowledge, facilities and personnel to treat

effectively (Williams-Tungpalan, 1981)

FACTORS ON THE VARIOUS CATEGORIES OF HEALTH WORKERS

AMONG COUNTRIES AND COMMUNITIES
1. available health manpower resources
2. local health needs and problems
3. political and financial feasibility

THREE LEVELS OF PRIMARY HEALTH CARE WORKERS

A. VILLAGE OR GRASSROOT HEALTH WORKERS
- first contacts of the community and initial links of health care.
- Provide simple curative and preventive health care measures
promoting healthy environment.
- Participate in activities geared towards the improvement of the socio-
economic level of the community like food production program.
- Community health worker, volunteers or traditional birth attendants.

B. INTERMEDIATE LEVEL HEALTH WORKERS

- represent the first source of professional health care
- attends to health problems beyond the competence of village workers
- provide support to front-line health workers in terms of supervision,
training, supplies, and services.
- Medical practitioners, nurses and midwives.

C. FIRST LINE HOSPITAL PERSONNEL

- provide back up health services for cases that require hospitalization
- establish close contact with intermediate level health workers or
village health workers.
- Physicians with specialty, nurses, dentist, pharmacists, other health
professionals.
TWO-WAY REFERRAL SYSTEM (Niace, et. al. 8th edition 1995)

A two-way referral system need to be established between each level

of health facility e.g. barangay health workers refer cases to the rural health
team, who in turn refer more serious cases to either the district hospital,
then to the provincial, regional or the whole health care system.

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
 Saint Mary’s University
SCHOOL OF HEALTH and NATURAL SCIENCES
Nursing Department
Bayombong, Nueva Vizcaya

Public

P Barangay Health

O Health Worker Nurse 2nd 3rd

P HF HF

U EA EA

L Barangay RHU AC AC

A Health Midwife Physician LI LI

T Stations TL TL

I HI HI

O T T

N RHS Sanitary Y Y

Midwife Inspector

MULTISECTORAL APPROACH TO HEALTH

(NLGNI, 8th edition, 1995)

The level of health of a community is largely the result of a

combination of factors.

Other health-related

Systems (government/
private

Ways of Community Health Care

The Health System

People

(Cultural)

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
 Saint Mary’s University
SCHOOL OF HEALTH and NATURAL SCIENCES
Nursing Department
Bayombong, Nueva Vizcaya

Environment (Social,

Economic, physical,

Etc.

Health, therefore, cannot work in isolation. Neither can one sector or

discipline claim monopoly to the solution of community health problems.
Health has now become a multisectoral concern. For instance, it is
unrealistic to expect a malnourished child to substantially gain in weight
unless the family’s poverty is
alleviated…… In other words, improvement of social and economic
conditions need to be attended to first or tackled hand in hand with health
problems.

1. Intersectoral Linkages
- Primary Health Care forms an integral part of the health system
and the over-all social and economic development of the
community. As such, it is necessary to unify health efforts within
the health organization itself and with other sectors concerned. It
implies the integration of health plans with the plan for the total
community development.

- Sectors most closely related to health include those concerned

with:
a. Agricultural
b. Education
c. Public works
d. Local governments
e. Social Welfare
f. Population Control
g. Private Sectors

The agricultural sector can contribute much to the social and

economic upliftment of the people……. Demonstration to mothers of
better techniques and procedures for food preparation and
preservation can preserve the nutritive value of local foods. Through
joint efforts, agricultural technology that produces side effects unsafe
to health (for instance, insecticide poisoning) can be minimized or
prevented.
The school has long been recognized as an effective venue for
transmission of basic knowledge to the community. Every pupil or

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
 Saint Mary’s University
SCHOOL OF HEALTH and NATURAL SCIENCES
Nursing Department
Bayombong, Nueva Vizcaya

student can be tapped for primary health care activities such as

sanitation and food production activities…..

Construction of safe water supply facilities and better roads can be

jointly undertaken by the community with public works. Community
organization (e.g. establishing a barangay network for health) can be
worked through the local government or community structure.
Likewise, better housing through social
welfare agencies, promotion of responsible parenthood through
family planning services and increased employment through the
private sectors can be joint undertakings for health……We have to
recognize that oftentimes health actions undertaken outside the
health sector can have health effects much greater than those
possible within it.

2. Intrasectoral Linkages
- In the health sector, the acceptance of primary health care
necessitates the restructuring of the health system to broaden
health coverage and make health service available to all. There is
now a widely accepted pyramidal organization that provides levels
of services starting with primary health and progressing to
specialty care. Primary health care is the hub of the health system.

A PYRAMIDAL HEALTH STRUCTURE

Tertiary
National Health
Health Care
Services

Regional
Health Services Secondary
Health
District Health Services Care
Rural (Local Hospital)
Services

Rural Health Units Primary

Barangay Health Stations Health
Care

THE NATIONAL HEALTH PLAN (Niace, et. al 8th edition 1995)

The National Health Plan is the blue print which is followed by the
Department of Health. It defines the country’s health problems, policy
thrusts, strategies and targets.

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
 Saint Mary’s University
SCHOOL OF HEALTH and NATURAL SCIENCES
Nursing Department
Bayombong, Nueva Vizcaya

POLICY THRUSTS AND STRATEGIES

There are policy thrusts and strategies which are commonly
important. These are:
1. Information, education, and communication programs will be
implemented to raise the awareness of the public, including policy
makers, program planners and decision makers;
2. An update of the legislative agenda for health, nutrition and family
planning (HNFP), and stronger advocacy for pending HNFP –related
legislations will be pursued;
3. Integration of efforts in the health, nutrition and family planning sector
to maximize resources in the delivery of services through the
establishment of coordinative mechanisms at both the national and
local levels;
4. Partnership between the public and the private sectors will be
strengthen and institutionalized to effectively utilize and monitor
private resources for the sector;
5. Enhancement of the status and role of women as program
beneficiaries and program implementers will be pursued to enable
them to substantially participate in the development process.

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269