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ARELLANO UNIVERSITY
2600 Legarda St. Sampaloc, Manila 1800
www.arellano.edu.ph

College of Radiologic Technology

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Course Subject: INTRODUCTION TO HEALTH CARE INDUSTRY
HAND-OUTS/LEARNING MATERIAL
Midterm/Semifinal Topics:
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TOPIC: Health Care Delivery System in The Philippines

LEARNING OBJECTIVE:
At the end of the topic, student should be able explain and discuss the health care setting of the
Philippines, its significance in the economic build-up of the country, its importance and the issues,
and milestone in the health of the people.
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DISCUSSION:
HEALTH CARE DELIVERY SYSTEM IN THE PHILIPPINES

HEALTH SITUATION IN THE PHILIPPINES

GEOGRAPHY AND SOCIO-DEMOGRAPHY

GEOGRAPHY
PHILIPPINES
• Is an archipelago in the South-East Asian Region, located between the South China Sea
and the Pacific Ocean
• Comprised of 7,107 islands
• Total land area: 343, 282 square kilometers
• Terrain is mountainous, with narrow to extensive coastal lowlands.
• Tropical and Maritime climate: High Temperature, high humidity and abundant rainfall.
• Lowest temp: 15 to 21 degrees centigrade
• Highest Temp: 35 degrees centigrade
• Dry Season: Dec –May
• Wet Season: June –November
• Typhoon belt of the western pacific
• Along the Pacific Ring of Fire
• One of the most-disaster prone area of the globe.

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DEMOGRAPHIC INDICATORS

Total Population as of 2018: 105.1 million – ranked as the 13th most populated country in the
world.

Philippine Growth Rate:

• A population growth rate of 2.04% annually is linked to a high average fertility rate of
three children per woman of child-bearing age.

• Highest population growth rates are observed in some of the most economically
deprived areas of the country, such as the Bicol and Eastern Visayas Regions

Religion
▪ Christians
▪ Roman Catholic
▪ others
▪ Muslim minority groups, comprising 5.6% of the household population are concentrated
in Mindanao
I80 ethnic groups
• Each representing their own language and culture
• Tagalog – 28% of the household population
• Cebuano, Ilonggo, Bisaya, bicol and Waray
Luzon – NCR, CAR, I, II, III, IV-A, IV-B,
Visayas – VI, VII, VIII
Mindanao – IX, X, XI, XII, XIII, ARMM
• Most of the population consists of Christian Malays living mainly on the coastal areas.

ECONOMIC CONTEXT

Economic Indicators
2016, the economy grew by 6.8%, the fastest in Asia, and 6.7% in 2017
Growth was mainly due to;
✓ Surge in investment and consumption
✓ Reconstruction and Public-private Partneship (PPP) in the infrasture sector
Domestic consumption is expected to remain the main driver of the economy, accounting for
70% of GDP.

INFLATION - is the rate at which the general level of prices for goods and services is rising and,
consequently, the purchasing power of currency is falling

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Main sectors of industry

1. Agricultural Sector
➢ Employs about 27% of the labour force but contributes only to 9% of GDP.
➢ Philippines is the second largest producer of coconuts
➢ Suffers low productivity, weak economies of scale and inadequate infrastructure.
Fishing
➢ contributes 1.5 % of the GDP
2. Industry Sectors
➢ contributes to 33% of GDP and employs 16% of the population
➢ Food processing
–main manufacturing activities
3. Services
➢ contributes to 33% of the GDP and 16% of the population
➢ Employs more than half of the country’s workforce.

***The Philippine is one of the most richest countries in the world in terms of unexploited minerals
wealth of more than USD 840 billion. Philippine reserves of copper, gold and zinc are among the
largest in the world.
INDUSTRY SECTOR: big industries are dominated by the production of cement, glass, chemicals,
products and fertilizers, iron, steel, and refined oil products.
Services and remittances from OFW are also major source of national income.

GROSS DOMESTIC PRODUCT (GDP)

➢ Is a monetary measure of market value of all final goods and services produced in a
period (quarterly or yearly) of time

Executive Power
PRESIDENT
➢ Head of the State and Government
➢ 6 year term
➢ Presides and appoint cabinet members
➢ Executive powers:
➢ Commander –in-chief

• LEGISLATURE
• Bicameral
• Parliament – Congress
• Senate
• House of Representatives
• Since 1897, the Philippines has had seven constitutions.
• The latest ratified by referendum in 1987 and now in effect, established a republican
government patterned after that of the United States with a strong executive branch, a
bicameral legislature, and an independent judiciary under a supreme court.

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Executive Branch
✓ National Government Agencies
✓ Local Government Units
Exercises administrative and/or regulatory authority over the Health system as a whole

Legislative Branch
Two influences:
❑ Approving annual budgets of national agencies and institution
❑ Allocation of development funds to a specific Health institutions for various purposes.

Judiciary
❑ affects health systems when it renders decisions in legal disputes involving health
agencies, institutions and individuals.
Political Context
Main Political Parties
✓ Diverse Ideologies
✓ works together to form coalition government

Health Status
✓ Women tend to live longer than men by five years, while average life expectancy at
birth for both sexes was about 72 years in 2007
✓ There are also variations in projected life expectancy at birth across different
regions.

LIFE EXPECTANCY
✓ -means the expected life span of the citizens in a particular or given country.
✓ Serve as an indicator of the state of development or improvement of the country.
▪ Regions III, IV, NCR and VII had the highest life expectancy for both men (67-
69 years) and women (74 years) in 2005.
▪ ARMM had a life expectancy of 58 years for men and 62 years for women,
reflecting the difficult living conditions brought by armed conflict, poverty,
poor nutritions and lack of health care.

Total population (2017): 103, 395, 947

Sex Ratio:
Male: 1.01
Female: 1.0
Fertility rate: 3.06 per woman (2016)
Crude Death Rate: 6.1. deaths per 1000 persons
Life Expectancy at birth (2016); 69.2 years
Characterized by: Triple burden diseases
o Communicable diseases
o Non-communicable diseases

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o Diseases of industrialization
DALY
➢ Disability Adjusted Life Years
➢ Measure of overall disease burden expressed as the number of years lost due ill-health,
disability or early death
• Both disability-adjusted life expectancy (DALE) and health-adjusted life expectancy
(HALE) are measures of the equivalent number of years expected to be lived in full
health.
• 1999, the DALE for Filipinos was approximately 57 years for men and 61 years for
women; in 2007, the HALE was 59 years for men and 64 years for women.
• leading cause of death in the Philippines is heart disease, with rates steadily rising from
70 per 100 000 population in 1997, to 90 per 100 000 population in 2005.

Communicable diseases continue to be major causes of morbidity and mortality in the

Philippines

morbidity rate
➢ is the frequency or proportion with which a disease appears in a population

Mortality Rate
➢ the number of deaths in a given area or period, or from a particular cause.

HEALTH REFORMS INITIATIVES

1979 - Adoption of Primary Health Care

➢ Promoted participatory management of the local health care system

1982 - Executive Order (EO) 851 “ Reorganization of DOH”

Integrated Public Health and hospital Services

1988 - The Generic Act

➢ Prescriptions are written using the generic name of the drug

1991 - Republic act (RA) 7160 “ Local Government Code”

➢ Transfer of responsibility of health service provision to the local government
units (LGU)

1995 - National Health Insurance Act

➢ Aims to provide all citizens a mechanism for financial protection with priority
given to the poor

1999 - Health Sector Reform Agenda

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➢ Major organizational restructuring of DOH to improve the way health care is

delivered

2005 - Formula One (F1) for Health

➢ Adoption of operational framework to undertake reforms with speed, precision,
and effective coordination

2008 - RA 9502 “Access to Cheaper and Quality Medicines Act”

➢ Promote and ensure access to affordable quality drugs and medicines for all

2010 - Administrative Order (AO) 2010-0036 “Kalusugan Panhgkalahatan”

➢ Universal health coverage and access to quality health care for all Filipinos

Major Areas of Reforms

1. Health Service Delivery
2. Health Regulation
3. Health Financing

Health Reforms targeted to address such issues as:

• Poor accessibility
• Inequity
• Inefficiency

LEADERSHIP AND GOVERNANCE

Department of Health (DOH)

➢ mandated to provide national policy direction and develop national plans,
technical standards and guidelines of health.
Function to:
▪ Provides technical assistance
▪ Capacity building
▪ Advisory services for disease prevention and control
▪ Supplies medicines and vaccines
Devolution of Health Services
Under the LGU code (1991); LGUs were granted AUTONOMY and RESPONSIBILITY for their own
health services

**National health programs are coordinated by the DOH through the LGUs

Challenges after the Devolution

• Due to the devolved set up of the health system, health reforms must not only be
implemented at the national level, these must also be promoted at the local
government levels

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• Difficulties in coordination between the DOH and local governments often lead to poor
policy implementation, and poorly functioning referral systems

• Health is not priority in most LGUs

• Lack of facilities and skilled health workers at the primary care level

Health System in ARMM

Different health systems from the other regions in the other country; not devolved

• Lack of funding
• Insurgencies
• Relative distance of some areas from the regional center

HEALTH SERVICE DELIVERY

The Philippine has a fragmented health system

• National Government
• Local Government Units
• Private sector

Level of Government Health Services

1. Preventive
2. Promotive
3. Curative

Perception towards government health services

• Perceived as low quality
• Poor diagnosis resulting to repeated visits
• Health human resources are not available and sometimes lacking in medical and people
skills
• Long waiting time
• Inconvenient facility schedule
• Run down or worn out facilities

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Levels of care and services provided

I. Primary Care Services

▪ Immunization
▪ Health and nutrition education
▪ Family planning services
▪ Treatment for minor illnesses and accidents
▪ Out-patient
▪ Dental
▪ Laboratory services

II. Secondary and Tertiary Services

▪ Out-patient
▪ In-patient
▪ Hospital Care
▪ Laboratory
▪ Special procedures
▪ Acute and emergency care
▪ Dental care
▪ Mental care

III. Rehabilitative Services

▪ Acute in-patient rehabilitation
▪ Long term care and program for the elderly and disabled
▪ Palliative care

Health Facilities

• General Hospitals
• Level 1 hospitals
• Level 2 hospitals
• Level 3 hospitals
• DOH Retaining Hospitals
• Specialty Hospitals

Other health facilities

• Primary care facility
• Custodial Care facility
• Diagnostic/Therapeutic facility
• Specialized outpatient facility

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Access and Quality of Health Services

WHO recommended 20 beds per 10,000 population
Philippines: 10 beds per 10,000 population

*** Despite the huge number health facilities are mostly concentrated in cities and urban
centers

“QUALITY” Why people go to private facilities

“Affordable” Why people go to public facilities

NATIONAL HEALTH ACCOUNTS

➢ Track the activities of the health sector through its health expenditures and
guide future decisions and actions

Total Health Expenditure (2014) Php 585.3B

Per capita expenditure on health (2014) 5, 859

Sources of Health Financing

➢ Out of pocket spending

o Burden of financing health care is still heaviest on individual families
➢ National and Local government
o Government health budgets are insurance funds
➢ National Health Insurance Program
o Movement towards a single-payer premium-based financing or insurance
system

HEALTH WORKFORCE

• Essentials for efficient management and operation of the public health systems
• Enormous but unevenly distributed in the country most are in Metro manila and urban
centers.

Migration
o Philippines is a major source of health professionals in the world
o Fluency in English and skills and training received
o Compassion and patience in caring
o Leading exporters of physicians but migrates as nurses
o Socio-economic and political situations do not contribute to retaining of licensed
and skilled professionals in the country

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Deployment programs of DOH

▪ Medical Pool Placement and Utilization Program (MPP-PUP)
▪ Doctors to the Barrios (DTTB)
▪ Registered nurses for Health Enhancement and Local Services (RN HEALS)
▪ Rural Health Midwives Program
▪ Rural Health Team Placement Program (RHTPP)

HEALTH INFORMATION closely reflects the larger health systems

Issues with Health Information in the Philippines

Information gaps
• National and local health information systems are poorly integrated and weakly
managed

Redundancies and duplication

• Information systems are fragmented and lacks interoperability among systems
• Vertical diseases surveillance systems

Lack of Information standards

• Private sector forms a large bulk of actual transactions with family physician and general
practitioners
• Lacking or absent from DOH information systems

Data Privacy Act (2012)

• An act protecting individual personal information in information and communication
systems in the government and the private sector.

Major Health Information Systems in the Philippines

• Philippine integrated Disease Surveillance and Response Project (PIDSR)

Early detection, reporting, investigation, assessment, and prompt response to emerging
diseases, epidemics and other public health threats.

• Philippine Health Information System

Integrated electronic system for storing and sharing vital health indicators

• Field Health Service Information Systems (FHSIS)

o Official Information system of the department of health
o Enables the collection and translation of information from local to national level
o information to policy formulation and decision making

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• Integrated Clinic Information System

o Supports the function of a clinic or other health care facility that is primarily
devoted to the care of outpatients by storing electronic records of health -
related data or an information to an individual
o In line with the PHIE and in and is interoperable with Philhealth Health
Information System, HOMIS (for hospitals) and DSWD (4Ps and WOMB)

RxBox
➢ A telemedicine device capable of capturing medical signals through built-in
medical sensor, storing data in an electronic medical record, and transmitting
health information via internet to a clinical specialist in the Philippine
General Hospital for expert advice.

Real Time Monitoring of Vital Maternal and Child Health Indicators through the
Community Health Information Tracking System (rCHITS)
➢ A free and open source software electronic health record system for local
government health centers in the Philippines.

Surveillance in Post Extreme Emergency and Disaster (SPEED)

➢ Mobile-internet-based disease surveillance system for disease by the DOH
HEMS and WHO
➢ Conceptualized to provide real time health information reporting after
disaster.

Philippine Health Information Exchange

➢ A platform for secure electronic access and efficient exchange of health data
and/or information among health facilities, health care providers, health
information organizations, and governing agencies in accordance with set
national standards in the interest of public health.

MEDICINES AND TECHNOLOGY

Pharmaceuticals

Filipinos are one of the highest consumers of pharmaceuticals in Southeast Asia (P750-800
annually on medicines and drugs per person).

Philippine Pharmaceutical market – segmented

• Asymmetric information
• Income disparities
• Inadequacy of the regulatory system

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Major Constraints in Assessing Essential Drugs

1. Limited availability
2. Irrational use
3. High cost
4. Local government are left to budget the medicines
5. Massive campaign by bigger manufacturing firms of their products
6. better incentives given to prescriber and dispensers of particular products
7. Prolonged patent rights
8. Lack of education on generics and patent issues
9. Shortcomings of information and education on pharmaceutical issues

High Price of Medicine

Supply Driven Distribution Scheme
• Drug stores: 80.1%
• Hospitals: 9.7% Govt. 2.3%
• Others: 10.2%

Strong market orientation

• Expensive branded medicine dominate the pharmaceutical market
• 10,000 drugs are off-patient but only 500 drugs are being manufactured

Poor compliance to Generic law

• Inadequacy to ascertain quality of medicine affects access to medicine and
patient health outcomes
• Claim better quality in comparison to more affordable and what are
perceived to be “inferior” products

Generally lax regulation with strong pharmaceutical or nutritiutical company lobbying

influence
• Aggravated by high promotion and gift-giving scheme done by drug
companies to health professionals

Medical Devices

General Radiography (basic x-ray)

Most basic equipment available across the country
Local government are left to budget for medical instrument, devices and
equipment

Rx BOX – reduces the overall cost of health care by enabling health workers to diagnose,
monitor and treat patients within the rural health facility.

Directions of the Philippine Health Sector: The Philippine Health Agenda (DOH AO 2016-0038)
https://www.doh.gov.ph

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