Community Health Nursing
The Philippine Health Care Delivery
System
Health Care Delivery System
 the totality of “societal services and activities
designed to protect or restore the health the health
o individuals
o families
o groups
o communities
 Includes government and non-government health
facilities, programs, services, and activities.
Public Health
 The science and art of preventing disease, prolonging
life, and promoting health and efficiency through
organized community effort...
 It is generally regarded as a responsibility of
government.
Three Core Functions of Public Health
1. Assessment
 The regular collection and analysis of health data
used for program planning and policy
development.
2. Policy Development
 Involves advocacy and political action to develop
policies in various levels of decision-making.
3. Assurance
 Making sure that health services are effective,
available and accessible to the people.
Ten Essential Health Services of Public Health
1. Monitoring health status to identify community health
problems.
2. Diagnosing and investigating health problems and hazards
in the community
3. Informing, educating, and empowering people about
health issues
4. Mobilizing community partnerships to identify and solve
health problems
5. Developing policies and plans that support individual,
family, and community efforts
6. Enforcing laws and regulations that protect health and
ensure safety
7. Linking people to needed personal health services and
ensuring the provision of health care that is otherwise
unavailable
8. Ensuring competent public health and personal health
care workforce.
9. Evaluating effectiveness, accessibility and quality of
personal and population-based health services
10. Researching for new insights and innovative solutions to
health problems
Two Sectors of the Philippine Health Care Delivery System
1. The Private Sector
 Provides health services for paying consumers.
This includes profit and non-profit health care
providers.
2. The Public Sector
  A largely financed through tax-based budgeting
system at both national and local levels.
 Health services are given free. The leading
national agency for health in the Philippines is the
Department of Health (DOH).
Department of Health (DOH)
 The national government’s biggest health (particularly
curative) care provider. Used to have control and
supervision on all health facilities but was
devolutionized
o regional hospitals
o medical centers
o special and specialty hospitals
o few re-nationalized provincial hospitals.
Executive Order 102
 Mandates the Department of Health to provide
assistance to local government units, people’s
organization, and other members of civic society in
effectively implementing programs, projects and
services that will promote the health and well-being
of every Filipino.
 It also includes also prevention and control of
diseases among population at risks, protect
individuals, families, and communities exposed to
hazards and risks that could affect their health, and
treat, manage, and rehabilitate individuals affected by
diseases and disability.
Devolution of Health Services
The RA 7160 or Local Government Code aims to transform local
government units into self-reliant communities and active
partners in the attainment of national goals through a more
responsive and accountable local government structure instituted
through a system of decentralization.
In 1993, the health services were transferred from the
Department of Health to the local government units. A Local
Health Board (LHB) was created to response to provincial, city,
and municipal health needs.
The Local Health Board in Provincial Level
 Governor (Chair)
 Provincial Health Officer (Vice-Chair)
 Chairman of the Committee on Health of the Sangguniang
Panlalawigan
 DOH Representative
 Non-Governmental Organization (NGO) Representative
The Local Health Board in Municipal Level
 Mayor (Chair)
 Municipal Health Officer (Vice-Chair)
 Chairman of the Committee on Health of the Sangguniang
Bayan
 DOH Representative
 Non-Governmental Organization (NGO) Representative
Two Levels of Primary Health Care Workers
1. Village or Barangay Health Workers (V/BHWs)
 Trained community health workers of health
auxiliary volunteer or a traditional birth attendant
or healer.
2. Intermediate Level Health Workers
 Includes general medical practitioners or their
assistants.
 Public health nurse, rural sanitary inspectors and
midwives may compose these groups.
Levels of Care
1. Primary Level of Care
 Devolved to the cities and the municipalities.
 The primary health facility is usually the first
contact between the community members and
the other levels of health facility.
2. Secondary Level of Care
 Care provided by physicians with basic health
training. Usually given in health facilities privately
owned or government operated.
 Capable of providing minor surgeries and perform
some simple laboratory examinations.
 Serves as a referral center for the primary health
facilities.
3. Tertiary Level of Care
 Care provided by specialists. Usually given in
medical centers, provincial hospitals, and
specialized hospitals.
 This is the referral system for the secondary care
facilities.
Global Health Situation (Millennium Goals)
 Poor health is a consequence and cause of poverty and
underdevelopment. The public health systems are
operating in the context of changes.
Public Health System Change Related Challenges
 Shifts in demographic and epidemiological trends in
diseases, including the emergence and re-emergence of
new diseases and in the prevalence of risk and protective
factors.
 New technologies for health care, communications, and
information
 Existing and emerging environmental hazards some
associated with globalization
 Health reforms.
In response to these changes the United Nations General
Assembly decided to adopt a common vision of poverty reduction
and sustainable development. This is exemplified by the 8
Millenium Developmental Goals (MDGs)
1. Eradicate Extreme Poverty and Hunger
2. Achieve Universal Primary Education (expected to be
achieved by 2015)
3. Promote Gender Equality and Empower Women
(expected to be achieved by 2015)
4. Reduce Child Mortality
5. Improve Maternal Health
6. Combat HIV/AIDS, Malaria, and Other Diseases
7. Ensure Environmental Sustainability, and
8. Develop a Global Partnership for Development
The Fourmula ONE is the implementation framework of the
Health Sector Reform Agenda (HSRA).
Goals of Formula One
 Better Health Outcomes
 More Responsive health Systems
 Equitable Health Care Financing
The Elements of the Strategy
1. Health Financing
 Goal: To foster greater, better and sustained
investments in health. The Philippine Health
Insurance Program (NHIP) and the Department of
Health will jointly support this.
 2. Health Regulation 11. Health Education
 Goal: To ensure the quality and affordability of 12. Maternal and Child Health and Family Planning
health goods and services. 13. Adequate Food and Proper Nutrition
3. Health Service Delivery 14. Provision of Medical Care and Emergency Treatment
 Goal: To improve and ensure the accessibility and 15. Treatment of Locally Endemic Diseases
availability of basic and essential health care both 16. Provision of Essential Drugs. (Cuevas)
public and private facilities and services.
4. Good Governance
 Goal: To enhance health system performance at Reference:
the national and local levels. Maglaya, A. (2008). Nursing Practice in the Community. Fifth
Edition. Marikina City, Philippines: Argonauta Corporation.
Primary Health Care (PHC)
 defined by the WHO and UNICEF as “essential health care
based on practical, scientifically sound, and socially
acceptable methods and technology made universally
accessible to individuals and families in the community
through their full participation and at a cost that the
community can afford to maintain at every stage of their
development in the spirit of self-reliance and self-
determination.

Essential Elements of PHC

1. Promotion of Adequate Food Supply and Proper Nutrition
2. Immunization Against the Major Infectious Diseases
3. Provision of Safe Water and Basic Sanitation
4. Maternal and Child Health Care, Including Family Planning
5. Prevention and Control of Locally Endemic Diseases
6. Appropriate Treatment of Common Diseases and Injuries
7. Provision of Essential Drugs
8. Environmental Sanitation (adequate supply of safe water
and good waste disposal).
9. Control of Communicable Diseases
10. Immunization