MODULE 02: CARDIOLOGY

Sustainable Development Goals & Non-Communicable Diseases

PAULO JOSE LUMICAO, MD-MBA, MSc, DPCOM
09/04/2021
FAMILY & COMMUNITY HEALTH

TABLE OF CONTENTS o Medical products and technologies

o Service delivery
I. THE WHO HEALTH SYSTEMS FRAMEWORK .............................................................. 1
II. SDGs ....................................................................................................................... 1
A. OVERVIEW ........................................................................................................ 1
B. WHAT ARE SDGs? ............................................................................................. 2
C. HEALTH IN THE SDG ERA ................................................................................... 2
III. SDG #3: ENSURE GOOD HEALTH AND WELL-BEING ............................................... 3
IV. GBD (2017): INSTITUTE OF HEALTH METRICS & EVALUATION ............................... 3
A. OVERVIEW ........................................................................................................ 3
B. FINDINGS .......................................................................................................... 3
V. NCDs ....................................................................................................................... 4
A. 7 INDICATORS/RISK FACTORS FOR NCDs .......................................................... 4
B. TRENDS ............................................................................................................. 4
C. POSITIVE DEVELOPMENTS ................................................................................ 5
D. CHALLENGES .................................................................................................... 5
VI. UNIVERSAL HEALTH COVERAGE ............................................................................. 6
A. WHO: SDG TARGET 3.8 ..................................................................................... 6
VII. UNIVERSAL HEALTH CARE (UHC) ACT (RA 11223) ................................................. 6
A. UHC .................................................................................................................. 6
B. EFFORTS COMPRISING THE UHC ACT ................................................................ 6 Figure 1. WHO health systems framework
C. KEEPING FILIPINOS HEALTHY & HEALTH LITERATE ............................................ 6
D. TAKING CARE OF FILIPINOS WHEN THEY NEED IT ............................................. 6 II. SDGs
E. THE PROMISE OF THE NATIONAL GOVERNMENT .............................................. 7 A. OVERVIEW
F. OVERALL ........................................................................................................... 7
VIII. ETHICAL EVALUATIONS OF THE ROLE OF SDGs .................................................... 7 • Adopted in September 2015 by the United Nations General Assembly
A. GENERAL RECOMMENDATIONS ....................................................................... 7 (UNGA) in New York, USA
IX. DEVELOPMENT OF SDG INDICATORS ..................................................................... 7 • Meant to provide global development efforts over the subsequent 15 years
A. ISSUES AND CONCERNS .................................................................................... 7 (2015-2030)
B. POSSIBLE VENUES OF TECHNICAL SUPPORT ..................................................... 7 • Replaced the Millennium Development Goals (2000-2015)
QUICK REVIEW ............................................................................................................ 8
SUMMARY OF CONCEPTS ..................................................................................... 8
• 17 SDGs with 169 targets
REVIEW QUESTIONS ............................................................................................. 9 • SDG 3
REFERENCES ............................................................................................................... 9 o “Ensure Good Health and Well-Being”
REQUIRED ............................................................................................................. 9 o 13 target outcomes
FREEDOM SPACE ........................................................................................................ 9
Millennium Development Goals (MDGs4)

LEARNING OBJECTIVES
1) Discuss an overview of the Sustainable Development Goals (SDGs1),
specifically SDG #3, and its targets
2) Discuss an overview of the Non-Communicable Diseases (NCDs2) as a
category in light of the SDG #3
3) Present an overview of data based on the Global Burden of Diseases (GBD3)
in the Philippine setting
4) Discuss the principle of Universal Health Coverage (UHC) as affirmed and
advocated by the World Health Organization (WHO)
5) Present an overview of the Philippine “Universal Health Care Act” and its
key concepts and provisions
Figure 2. MDGs
I. THE WHO HEALTH SYSTEMS FRAMEWORK
• Public Health in ASMPH emphasizes the system building blocks of health to • 8 goals with 18 targets
achieve overall goals and outcomes: • UN evaluated that MDGs 4, 5, and 6 were not achieved by the end of its
o Improved health (level and equity) term
▪ Equity is giving everyone what they need to be successful • Begs the following questions:
o Responsiveness o Were MDGs 1, 2, 3, 7, and 8 achieved?
▪ Health seeking behavior ▪ Some would claim they have never been achieved
o Financial risk protection o What about the ones outside those key values?
▪ Against the rising cost of healthcare services o Are we accepting conclusions which may be harmful for individuals
o Improved efficiency outside those key values by employing purely outcomes- or utilitarian-
▪ Productivity in workforce and economy based perspective?
• Can only be realized with safe, good-quality access and coverage to system o Are these goals only exclusive for specific populations?
building blocks
o Leadership/governance
o Health financing
o Health workforce
o Information

1 SDGs: Sustainable Development Goals 3 GBD: Global Burden of Diseases

2 4
NCDs: Non-communicable diseases MDGs: Millennium Development Goals

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Evaluation of MDGs in the Philippines
• The Philippines has not achieved MDGs 4 and 5
• Current health status in the Philippines
o Remain deeply underserved:
▪ High infant-child-maternal mortality rates, especially among the
poor
▪ Prevalent malnutrition
▪ Decreased immunization rate for children
▪ Belong to lower ranks in average life expectancy, maternal mortality
ratio, and under 5 mortality rate
▪ Worst in TB incidence rate compared to other SEA countries
Figure 3. Slide set introduction to the Universal Health Care Act from DOH
Philippines
B. WHAT ARE SDGs?
• Goals that reflect concerns that countries face, with a strong focus on
principle of equity
o Equity and equality are strategies used to produce fairness
▪ Equity: giving everyone what they need to be successful
▪ Equality: treating everyone the same
• Statement of aspirations
o Voluntary agreements rather than a binding treaty
o Since it is non-binding, there is no guided technical international effort
• “Windows of opportunity”
o For government and non-governmental organizations to collaborate
o Leadership and advocacy from various groups (political and non-
political) allowing imaginative thinking about inclusivity, and to create
technical guided effort
• Limitations include questions on the accountability of its goals
o Who should enforce these technical guides?
o How should these technical guides be enforced?
[VIDEO] WHAT ARE SDGs?
• In 2000, leaders from 189 countries agreed on a vision to end extreme
poverty in all of its forms through the MDGs.
o Projected to be achieved in 15 years
• MDGs:
1) Eradicate extreme hunger
2) Achieve universal primary education
3) Promote gender equality and empower women
4) Reduce child mortality
5) Improve maternal health
6) Combat HIV/AIDS, malaria, and other diseases
7) Ensure environmental sustainability
8) Global partnership for development
• The United Nations Development Program (UNDP) is one of the leading
organizations working to fulfill these goals.
o Present in more than 170 countries and territories
o Funded projects that help fulfill the goals
o Helped countries accelerate MDG progress by breaking down the
silos and working across sectors
o Acted as scorekeeper to help countries track their progress
o Has 50 years of experience working with countries to make this a
more prosperous, healthy, inclusive, and sustainable world
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[VIDEO] WHAT ARE SDGs? (cont.)
• Results of the MDGs:
o People living on less than $1.25 dropped by more than half
o Number of primary school-aged kids who don’t go to school
decreased by almost half
o Number of people getting life-saving treatment for HIV increased by
over 15 times
o Child mortality decreased by almost half
• Despite the progress achieved by the MDGs, there’s still a lot more to
do.
o Over 800 million people are still living on less than $1.25 per day
o 1 in 9 people goes to sleep hungry each night
o Deforestation remains alarmingly high in many countries
o Oceans are becoming more acidic, threatening food security and
marine ecosystems
o About 1 in 6 adults in the world is illiterate and 2/3 of them are
women
• In September 2015, the SDGs were formed to help finish the progress
achieved through the MDGs.
• The situation today:
o The world is more connected by technology.
o We know more about how to balance the three pillars of sustainable
development: social progress, economic growth, and
environmental protection.
o Our climate is changing, and our planet is transforming.
• There are more people on Earth than ever before.
C. HEALTH IN THE SDG ERA
• Focus is not on SDG 3 of good health and well-being alone
o We also need to think about other determinants of health.
o We can only and ultimately realize health and wellbeing if we also
address the following:
▪ Health needs of the poor in SDG 1
▪ Food in SDG 2
▪ Education in SDG 4
▪ Sanitation in SDG 6
• Health can be achieved by realizing the targets of other SDGs.
• WHO definition of health: a state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity
o Consider the different determinants to achieve physical, mental, and
social well-being
Figure 4. WHO definition of health
ACTIVE RECALL
1. T/F. Equality means giving everyone what they need to be successful.
2. Identify. The UN determined that these MDGs had not been achieved
by 2015.
3. T/F. Good health and wellbeing can be achieved by focusing on SDG 3
alone and not addressing other SDGs.
ANSWERS: 1F – Equity, 2 MDGs 4 – Reduce child mortality, 5 – Improve
maternal health, and 6 – Combat HIV/AIDS, malaria, and other diseases,
3F
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 III. SDG #3: ENSURE GOOD HEALTH AND WELL-BEING A. OVERVIEW
• SDG 3 has a total of 13 targets with target 3.8 as its overarching target • Data of IHME 2017:
o Target 3.8: achieve universal health coverage, including: o Total population: 103.5M
▪ Financial risk protection ▪ Roughly 106.7M (2020)
▪ Access to quality essential health-care services, medicines, and o Per capita GDP: $7,426
vaccines for all o Fertility rate: 3.1
• Includes MDG unfinished and expanded agenda: o Educational attainment (years): 9.6
o Reducing maternal mortality o Life expectancy:
o Ending preventable newborn and child deaths ▪ Females: 73.1 (observed)
o Ending the epidemics of HIV, TB, malaria, and neglected tropical ▪ Males: 66.6 (observed)
diseases and combating hepatitis, waterborne, and other ▪ Has improved over the span of 20 years
communicable diseases
o Ensuring universal access to sexual and reproductive health-care
services
• New SDG 3 targets include:
o Reducing mortality from NCDs
o Strengthening prevention and treatment of substance abuse
o Halving global deaths and injuries from road traffic accidents
o Reducing deaths from hazardous chemicals and air, water, and soil
pollution and contamination
• SDG 3 means of implementation targets include:
o Strengthening implementation of WHO framework convention on
tobacco control
▪ Seeks to protect generations from devastating health, social,
environmental, and economic consequences of tobacco
▪ Also involves enacting a set of universal standards stating the
dangers of tobacco
o Providing access to medicines and vaccines for all and supporting
research and development of vaccines and medicines for all Figure 6. Life expectancy in the Philippines, 1990-2017
o Increasing health financing and health workforce in developing • How are Filipinos’ life expectancies compared to other Asian countries?
countries o South Korea: 85 for females, 79 for males
o Strengthening capacity for early warning, risk reduction, and o Malaysia: 77 for females, 72 for males
management of health risks • Are there factors that contribute to our life expectancies here in the
Philippines? Is it because of diet, behavior, or infections?

B. FINDINGS

Figure 5. SDG #3
Figure 7. Top 10 causes of death
ACTIVE RECALL
• What causes the most deaths?
4. Which of the following is NOT a new SDG 3 target?
o There has been a steady rise and ranking of NCDs (i.e., ischemic heart
a) Reducing mortality from NCDs
disease, stroke, CKD, diabetes, hypertensive heart diseases, COPD)
b) Strengthening prevention and treatment of substance abuse
c) Ending preventable newborn and child deaths
d) Halving global deaths and injuries from road traffic incidents
5. Identify. The overarching target of SDG 3.

ANSWERS: 4C, 5 Target 3.8 – achieve universal health coverage

IV. GBD (2017): INSTITUTE OF HEALTH METRICS & EVALUATION

As you will see, this session focuses more on the impact of non-
communicable diseases. Thus, it is imperative to present an overview of
data based on health statistics about the Philippine setting.

• Institute of Health Metrics & Evaluation (IHME)

o Research institute working in the area of global health statistics and
impact evaluation at the University of Washington, Seattle
o Demographic studies on country trends in mortality, diseases, and risk
factors
o Capsulizes many of its research findings in data visualizations
o Based on over 80,000 different data sources used by researchers to
produce the most scientifically rigorous estimates possible
o Estimates may differ from national statistics due to differences in data
sources and methodology
Figure 8. Top 10 causes of years of life lost
• What causes the most premature deaths?
o Most premature deaths result from NCDs and NOT from
communicable disease
o Would be interesting to see how this data would play out after
extrapolating data from the current pandemic

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 Figure 9. Top 10 causes of years lived with disability

• What health problems cause the most disability?

o NCDs are still the most prevalent factors

Figure 11. Global mortality (% of total deaths)

A. 7 INDICATORS/RISK FACTORS FOR NCDs

I. Prevalence of tobacco use
II. Percentage of alcohol drinker engagement in hazardous and harmful
Figure 10. Top 10 risks contributing to disability-adjusted life years (DALYs) drinking
III. Prevalence of low physical activity
• What risk factors drive the most death and disability combined? IV. Prevalence of overweight BMI
o Both metabolic and behavioral risk (i.e., dietary intake, high fasting
V. Prevalence of obese BMI
glucose, malnutrition, tobacco use, high BP, high BMI, high LDL,
VI. Prevalence of raised blood pressure, excluding those on medication
impaired kidney function, alcohol intake)
VII.Prevalence of raised blood glucose, currently on DM medications

ACTIVE RECALL B. TRENDS

6. T/F. As of 2017, most deaths were caused by communicable diseases • Overall, there has been a steady decline in NCD mortality rates in the past
(e.g., lower respiratory tract infections). 10 years because of:
7. Which of the following is NOT considered an NCD? o Therapeutics
a) Ischemic heart disease o Health seeking behavior
b) Stroke o Health education
c) Diabetes
d) Tuberculosis

ANSWERS: 6F, 7D

V. NCDs
• The WHO categorized four diseases belonging to the NCDs category:
o Cardiovascular diseases (CVD)
o Diabetes mellitus (DM)
o Chronic respiratory diseases (CRD)
o Cancer
• About 52% of deaths are mostly based on NCDs, with CVD occurring 6
million per year worldwide

Figure 12. Probability of death from 4 main NCDs (CVD, cancer, CRD, and DM)
between ages 30 and 70, by region and globally, 2000 and 2012

• However, if we evaluate the target set by the WHO, it seems like each
region all over the world is still unable to meet the targets
o As seen on the yellow and red targets on Figure 12

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 C. POSITIVE DEVELOPMENTS
• Lack of preventive action
• Limitations in primary healthcare, access to medicines and technology
• Profit driven disease
• Rapid, unplanned urbanization
• Ageing population
• Inequalities
Figure 13. Spectrum of health promotion interventions
• NCDs are characterized by multiple interlinked chains of causation
• There are positive developments realized in curbing the rise of NCDs in the
past 10 to 20 years
• Important lessons:
o Focus on global prevention
▪ More and more individuals are exposed to “information, education,
and communication” (IEC) materials that are individual- or
population-based
▪ Mass and environmental based in approach
▪ Health promotions are being realized in the workplace
▪ Health promotion interventions are being realized in school, in the
community, and even in the physician and patient clinical encounter
through patient education
o Global action
▪ Establishment of Framework Convention on Tobacco Control
(FCTC) which enacted a set of universal standards stating the
dangers of tobacco
 The Philippines has been a party since 2005
▪ The FCTC demonstrated national commitments to implement
tobacco policies that are legally binding and evidence based
 Targeted 30% reduction in tobacco use by 2025
o Multisectoral responses
▪ Varied multisectoral responses, both government- and non-
government-initiated
 2012 Sin Tax Law (RA 10351)
- Cigarette packs should not be less than 60 pesos per pack
- 85% of revenues would go to health and 15% tobacco
producing regions
 2016 BLS Training Schools (RA 10871)
- Emphasizing that all public and private basic education
schools will provide students with basic life support training
in age-appropriate manners through the Philippine Heart
Association and Red Cross
 2017 Nationwide Smoking Ban (EO 26)
o Early detection, diagnosis, and treatment
▪ More and more individuals are proactive to do executive health
checkups or annual physical examinations and laboratory
examinations such as FBS, lipid profiles, etc.
o Integrated approaches to NCD care
▪ Private company-initiated wellness fairs and programs
[VIDEO] NON-GOVERNMENTAL RESPONSE BY THE PHILIPPINE HEART
ASSOCIATION
• Philippine Heart Association holds a CPR mass campaign
o Ongoing since 2016
o Teaches hands-only CPR
o Aims to make the Philippines CPR ready by 2021
o Target: at least one member of each household who knows how to
do age-appropriate CPR
o Includes children and parents, students, and government and non-
government officials
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D. CHALLENGES
o Country regions are not able to reach WHO targets
o There is still lack of preventive efforts with enablers in culture and
society
o Starkly and evidently realized in geographically isolated and
disadvantaged areas (GIDAs)
o Rise of fast-food chains
o Enabling a more sedentary lifestyle
o Patients with chronic conditions suffering from several diseases
simultaneously making their treatment more complex and with an
increase in the need of quality care
o Health care inequalities are obviously a societal cancer
[VIDEO] NCDs AND THEIR RISK FACTORS
• NCDs have increased as a result of:
o Population aging
o Urbanization
o Globalization
o Changes in lifestyle
• Considered the “great epidemic of our age”
• Preventable by adopting a healthy lifestyle, but this requires more than
personal determination
• Examples of hindrances to a healthy lifestyle:
o Wholesome food is more expensive and less available than junk food
o Physical activity is a challenge - parks and recreation areas are not
safe or properly equipped
o It’s hard to quit smoking or drinking because advertising abounds
• Laws and regulations are needed to make the healthiest choice the
easiest choice
• Examples of regulations that encourage healthy choices:
o Reformulating processed foods to make them healthy
o Informing consumers about nutrition content of packaged food
o Making fresh food more available
o Regulating junk food sale and providing free drinking water in schools
o Increasing taxes on tobacco, alcohol, and sugar-sweetened
beverages
o Facilitating access to quit-smoking programs and banning tobacco
use in enclosed public spaces
o Limiting advertising of cigarettes, alcohol, and junk food
o Creating opportunities for physical activity (e.g., creating
recreational bicycle paths and promoting the use of public
transportation)
o Ensuring access to health services (e.g., early detection of disease,
diagnosis, medicines, and treatment) provided without
discrimination and without undue financial hardship
• People should be provided with information and support that empowers
them to manage their own health
• Healthy public policies and healthy lifestyles are the prescription to
prevent and control NCDs
SOURCE: Noncommunicable Diseases and their Risk Factors (animated
video) (by PAHO TV)
ACTIVE RECALL
8. Which of the following is NOT a risk factor for NCDs?
a) Prevalence of low physical activity
b) Prevalence of raised BP, including those on medication
c) Prevalence of tobacco use
d) Prevalence of overweight BMI
9. Identify. The 4 NCDs categorized by the WHO.
ANSWERS: 8B – Prevalence of raised BP, excluding those on medication, 9
CVD, DM, chronic respiratory diseases, cancer
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 VI. UNIVERSAL HEALTH COVERAGE VII. UNIVERSAL HEALTH CARE (UHC5) ACT (RA 11223)
A. WHO: SDG TARGET 3.8 A. UHC
• UHC means:
Universal Health Coverage: all people receive health services they need
o Healthy living, schooling, and working environments
(health initiatives to promote better health, prevent illness, and to
o Primary care provider team for every family
provide treatment, rehabilitation, and palliative care) to be effective
▪ Ensures that they get the appropriate services they need in the
while at the same time ensuring that the use of services does not expose
appropriate facilities
them to financial hardship.
o Health spending is predictable, not “lahat libre”
• Universal health coverage as one overarching target for SDG 3 ▪ PhilHealth ensures they are protected from financial risk
• To achieve universal health coverage, community must be able to advance o Care is provided by providers organized as integrated networks
the 6 components/building blocks:
1) People: health workers/health workforce B. EFFORTS COMPRISING THE UHC ACT
2) Services: health services/treatment
3) Products: health products/medicine
4) Finances: health financing/payment
5) Policies/governance: health leadership/policies in place
6) Information: getting the right information to make decisions about
the whole system

Two Indicators
Essential Health Services Coverage Index
• Summary of coverage
• A way of tracking progress across a range of services within a country based
on 4 main categories:
1) Reproductive, maternal, newborn, and child health
2) Infectious diseases
3) NCDs
4) Service capacity and access
Figure 14. Efforts comprising the UHC Act
• Gaps to address to reach full coverage:
o Certain countries do not prioritize public health, which makes data • 80% health promotion efforts, of which:
collection difficult o 40% socioeconomic factors
o Some countries are nearer the target o 10% physical environment
o 30% health behaviors
Financial Protection o 50% (socioeconomic factors and physical environment) can be traced
back to your zip code
• Achieved when payments made to obtain health services do not expose
people to financial hardship • 20% health service coverage access and risk protection indicators
o 20% health care
• 2 indicators:
▪ Includes those moments in a healthcare environment
1) Health spending
◼ Actual out-of-pocket payments for health services by each
patient/individual C. KEEPING FILIPINOS HEALTHY & HEALTH LITERATE
2) Health care costs Sec. 7, 17
◼ Health care service costs in the market
• Fund public health programs and commodities
◼ Continue to rise due to:
o Family planning
 Out-of-pocket payments
o Nutrition program
 Medicines, use of private providers o Mental health program
o Both indicators decrease financial protection
Sec. 30
ACTIVE RECALL • Pass/implement pro-health legislation
10. Which of the following is NOT one of the 4 categories covered by the o No smoking (e.g., in the workplace, community)
Essential Health Services Coverage Index? o Community-based drug rehabilitation
a) Reproductive, maternal, newborn, and child health • Ensure that health impact assessment and public health mitigation and
b) Infectious diseases management plans are done prior to approval of risky development
c) NCDs projects
d) Mental health o Health impact assessment is a method employed for the screening,
11. T/F. Health spending involves service costs in the market, while scoping, appraising, reporting, and monitoring of public health
healthcare costs include actual out-of-pocket payments by each programs
patient. o Tries to develop what health promotion efforts are effective to address
family planning, nutrition, mental health issues, smoking issues in the
ANSWERS: 10D – The 4th category is service capacity and access, 11F – It’s community and the workplace, and drug rehabilitation
the other way around
D. TAKING CARE OF FILIPINOS WHEN THEY NEED IT
Sec. 7, 17
• Invest in functional primary care clinics (rural health units, barangay health
station, birthing homes) with e-health capabilities (e.g., telemedicine,
electronic health records)

Sec. 28
• Make prices of all services transparent
• If there is a transparent price list, sick patients can predict their
expenditures

5 UHC: Universal health care

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Sec. 29
• Ensure that at least 90% of beds in all government hospitals are no balance
billing beds
o Policy enabling the vulnerable population to pay no more in excess of
their PhilHealth coverage when confined in government hospitals
o No direct medical expense shall be exacted from the patient for the
duration of the confinement
o Makes treatment entirely free for the beneficiaries
o Popularly known as “walang dagdag bayad”
E. THE PROMISE OF THE NATIONAL GOVERNMENT
Sec. 18
• Healthcare providers and facilities enrolled to the integrated health
network will receive higher reimbursements paid in advance
• More primary care physicians become reimbursed with their services
• Structural reforms
o Need to reform arrangements in government/nongovernmental
development assistance
o Filipinos are now privileged because of the legislation of UHC Act and
its enactment into law
o This will need structural reforms and that is why a health impact
assessment will play a crucial role in the rollout of UHC Act
• Definitions, measurement methods, and progress tracking
o Technical expertise by independent high-level experts to ensure
measurement of progress
o Remain to be in question because they vary from country to country
ACTIVE RECALL
14. T/F. The SDGs provide strict guidelines that ensure accountability.
15. T/F. Health impact assessment plays a crucial role in the rollout of the
UHC Act.

Sec. 7, 24 ANSWERS: 14F, 15T

• Provide public health commodities
• Deploy health workers (primary care, family medicine physicians),
especially to geographically isolated and disadvantaged areas IX. DEVELOPMENT OF SDG INDICATORS
A. ISSUES AND CONCERNS
Sec. 28 • Data availability and disaggregation
• Lack of clarity of technical terms used
• Make centrally negotiated pricing available especially for high-cost drugs
o No clear definitions of terms used for indicators
and services
o Makes expenditures predictable • Need to check overlaps and inconsistencies of concepts of indicators across
goals
• Accountability and ownership
F. OVERALL • Budget
• The UHC Act is all about health promotion
• Population coverage
B. POSSIBLE VENUES OF TECHNICAL SUPPORT
o Automatic inclusion of every Filipino citizen into the NHIP
• Service coverage • Capacity building
o Immediate eligibility and access • Improvement of data system/data generation, instruments for subnational
o Comprehensive outpatient benefit of services and local level monitoring
o Provision of primary care provider that is registered in integrated • Advocacy/IEC campaigns
healthcare networks as a gatekeeper • Conduct of regular surveys
• Financial coverage • Manpower
o Zero co-payment
o Fixed, predictable co-payment [VIDEO] UHC ACT
• It means everyone wins
• RA 11223
o Filipinos/patients are health literate, practice healthy lifestyles, live in
• Signed by President Rodrigo Duterte
low-risk environments, receive effective care without financial hardship
• Automatically makes all Filipinos PhilHealth members
o Health care workers earn decent predictable income and are able to
pursue career paths • Entitles PhilHealth members to free:
o Suppliers of drugs, devices, and diagnostic tests that improve outcomes o Medical consultations
o Lab tests
and/or lower total costs find their products incorporated into treatment
o Other diagnostic services
protocols used and reimbursed
o Payers (private insurers, governments, or self-pay individuals) able to • 3 dimensions:
shape provider behavior towards quality and efficiency 1) Haba/length: population that should benefit from UHC (all
o Providers earn a positive margin for producing outcomes at low cost Filipinos)
2) Lawak/width: kinds of services Filipinos can avail of
3) Lalim/depth: percentage of costs shouldered by patients
ACTIVE RECALL • This is a good start for the Philippine healthcare system, but so much
12. T/F. The UHC Act requires that at least 75% of beds in government more needs to be done to make healthcare truly universal in the
hospitals are no balance billing beds. Philippines.
13. T/F. The UHC Act aims to make expenditures predictable by ensuring
medical services are free.
ACTIVE RECALL
ANSWERS: 12F – 90%, 13F – UHC does not mean lahat libre 16. Which of the following is NOT an issue in the development of SDG
indicators?
a) Budget
VIII. ETHICAL EVALUATIONS OF THE ROLE OF SDGs b) Data availability and disaggregation
• Gives us insight about the implementation of the goals c) Manpower
• SDGs are statements of aspirations which only allow social encouragement, d) Accountability and ownership
and thus, are non-binding and non-enforceable 17. Identify. The dimension of the UHC Act that pertains to the kinds of
services Filipinos can avail of.
A. GENERAL RECOMMENDATIONS
• Accountability ANSWERS: 16C, 17 Lawak/width
o SDGs do not provide accountability on different agencies, unless the
governments participate through their own legislations HOW’S MY TRANSING?
o Need to stipulate responsibilities of competent agents
o Who is supposed to do what to get it accomplished? Feedback Form: https://tinyurl.com/2024YL7HMTForm
o What efforts does it require from states domestically, states acting Errata Tracker: https://tinyurl.com/2024YL7ET02
beyond borders, international agencies, multinational enterprises?

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 QUICK REVIEW • 7 indicators/risk factors for NCDs:
SUMMARY OF CONCEPTS 1) Prevalence of tobacco use
2) Percentage of alcohol drinker engagement in hazardous and harmful
THE WHO HEALTH SYSTEMS FRAMEWORK
drinking
• Goals/outcomes:
3) Prevalence of low physical activity
o Improved health
4) Prevalence of overweight BMI
o Responsiveness
5) Prevalence of obese BMI
o Financial risk protection
6) Prevalence of raised blood pressure, excluding those on medication
o Improved efficiency
7) Prevalence of raised blood glucose, currently on DM medications
• 6 system building blocks:
• Important lessons:
1) Leadership/governance
o Focus on global prevention
2) Health financing
o Global action
3) Health workforce
o Multisectoral responses
4) Information
o Early detection, diagnosis, and treatment
5) Medical products and technologies
o Integrated approaches to NCD care
6) Service delivery
• Challenges:
o Lack of preventive action
SDGs
o Limitations in primary healthcare, access to medicines and technology
• MDGs 4, 5, and 6 were not achieved by 2015
o Profit driven disease
• What are SDGs? o Rapid, unplanned urbanization
o Goals that reflect concerns that countries face, with a strong focus on o Ageing population
principle of equity o Inequalities
o Statement of aspirations
▪ Voluntary agreements rather than a binding treaty UNIVERSAL HEALTH COVERAGE
▪ No guided technical international effort
• Universal health coverage as one overarching target for SDG 3
• 3 pillars of sustainable development:
• In order to achieve universal health coverage, community must be able to
1) Social progress
advance the 6 system building blocks
2) Economic growth
• 2 indicators:
3) Environmental protection
o Essential Health Services Coverage Index
• Health in the SDG era
▪ A way of tracking progress across a range of services within a country
o Apart from SDG 3, the following must also be addressed to realize
based on 4 main categories:
health and wellbeing:
 Reproductive, maternal, newborn, and child health
▪ SDG 1: health needs of the poor
 Infectious diseases
▪ SDG 2: food
 NCDs
▪ SDG 4: education
▪ SDG 6: sanitation  Service capacity and access
o Financial protection
SDG #3: ENSURE GOOD HEALTH AND WELL-BEING ▪ Achieved when payments made to obtain health services do not
expose people to financial hardship
• Overarching target: Target 3.8 – achieve universal health coverage,
▪ 2 indicators:
including financial risk protection and access to quality essential healthcare
services, medicines, and vaccines for all  Health spending
• Includes the MDG unfinished and expanded agenda  Health care costs
• New SDG 3 targets include:
UHC ACT (RA 11223)
o Reducing mortality from NCDs
o Strengthening prevention and treatment of substance abuse • UHC means:
o Halving global deaths and injuries from road traffic accidents o Healthy living, schooling, and working environments
o Reducing deaths from hazardous chemicals and air, water, and soil o Primary care provider team for every family
pollution and contamination o Health spending is predictable, not “lahat libre”
o Care is provided by providers organized as integrated networks
• Means of implementation targets:
o Strengthening implementation of WHO framework convention on • Keeping Filipinos healthy & health literate
tobacco control o Sec. 7, 17: fund public health programs and commodities
o Providing access to medicines and vaccines for all and supporting o Sec. 30
research and development of vaccines and medicines for all ▪ Pass/implement pro-health legislation
o Increasing health financing and health workforce in developing ▪ Ensure that health impact assessment and public health mitigation
countries and management plans are done prior to approval of risky
o Strengthening capacity for early warning, risk reduction, and development projects
management of health risks • Taking care of Filipinos when they need it
o Sec. 7, 17: invest in functional primary care clinics (rural health units,
GBD (2017): INSTITUTE OF HEALTH METRICS & EVALUATION barangay health station, birthing homes) with e-health capabilities
• There has been a steady rise and ranking of NCDs (i.e., ischemic heart (e.g., telemedicine, electronic health records)
disease, stroke, CKD, diabetes, hypertensive heart diseases, COPD) o Sec. 28: make prices of all services transparent
o Sec. 29: ensure that at least 90% of beds in all government hospitals are
• Most premature deaths result from NCDs and NOT from communicable
no balance billing beds
disease
• The promise of the national government
• Both metabolic and behavioral risk (i.e., dietary intake, high fasting
o Sec. 18: healthcare providers and facilities enrolled to the integrated
glucose, malnutrition, tobacco use, high BP, high BMI, high LDL, impaired
health network will receive higher reimbursements paid in advance
kidney function, alcohol intake) drive the most death and disability
o Sec. 7, 24
combined
▪ Provide public health commodities
▪ Deploy health workers, especially to geographically isolated and
NCDs
disadvantaged areas
• The WHO categorized four diseases belonging to the NCDs category:
o Sec. 28: make centrally negotiated pricing available especially for high-
o Cardiovascular diseases (CVD)
cost drugs and services
o Diabetes mellitus (DM)
o Chronic respiratory diseases (CRD)
o Cancer

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ETHICAL EVALUATIONS OF THE ROLE OF SDGs EXPLANATIONS:
• General recommendations: 3. D. Launching a nationwide campaign about COPD management – A and B
o Accountability address the MDG unfinished and expanded agenda. C addresses an SDG 3
o Structural reforms means of implementation target.
o Definitions, measurement methods, and progress tracking 5. A. Only the first statement is true – The SDGs do not form a binding treaty,
nor are they guided by technical international effort.
DEVELOPMENT OF SDG INDICATORS 6. D. Both statements are false – Both metabolic and behavioral risks drive
• Issues and concerns: death and disability. Age expectancy has been increasing.
o Data availability and disaggregation
o Lack of clarity of technical terms used REFERENCES
o Need to check overlaps and inconsistencies of concepts of indicators REQUIRED
across goals
(1) Paulo Jose Lumicao. 04-09-21. Introduction to the Sustainable
o Accountability and ownership
Development Goals, Non-communicable Diseases, & Universal Health
o Budget
Coverage [Lecture slides].
• Possible venues of technical support:
 PAHO TV. 12-04-17. Noncommunicable Diseases and their Risk Factors
o Capacity building
(animated video) [Video]. Retrieved from
o Improvement of data system/data generation, instruments for
[https://www.youtube.com/watch?v=fK1_SH3X2ek].
subnational and local level monitoring
o Advocacy/IEC campaigns
o Conduct of regular surveys FREEDOM SPACE
o Manpower

DIMENSIONS OF UHC ACT

• Haba/length: population that should benefit from UHC
• Lawak/width: kinds of services Filipinos can avail of
• Lalim/depth: percentage of costs shouldered by patients

REVIEW QUESTIONS
Which of the following is FALSE regarding the promise of the government
in the UHC Act?
a) Sec. 7, 24: provision of public health commodities
b) Sec. 28: make centrally negotiated pricing available
c) Sec. 18: healthcare providers and facilities enrolled to the integrated
health network will receive higher reimbursements paid in advance
d) None of the above

A government hospital in Antipolo City increased its services when they

added a new dialysis center and accepts PhilHealth members. This scenario
addresses which dimension of the UHC Act?
a) Haba/length
b) Lawak/width
c) Lalim/depth
d) None of the above

Which of the following scenarios attempts to fulfill one of the new targets
under SDG 3?
a) A medical mission to one GIDA in Leyte aiming to vaccinate children
b) Holding FGDs among pregnant women to assess their needs
c) The national government awards funding to look at the efficacy of
ivermectin in curing COVID-19
d) Launching a nationwide campaign about COPD management

Charlie has been more proactive in getting himself scheduled for annual
physical check-ups. This positive development is an example of:
a) Focus on global prevention
b) Global action
c) Early detection, diagnosis, and treatment
d) Multisectoral responses

SDGs are statement of aspirations. Therefore, it is a voluntary agreement

and a binding treaty with guided technical international effort.
a) Only the first statement is true
b) Only the second statement is true
c) Both statements are true
d) Both statements are false

Only metabolic risk drives the most deaths and disabilities. Age expectancy
in both men and women in the Philippines have slowly decreased within
the past 20 years.
a) Only the first statement is true
b) Only the second statement is true
c) Both statements are true
d) Both statements are false

ANSWERS:
1D, 2B, 3D, 4C, 5A, 6D

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