OPENING PRAYER

NCM 104
HEALTH CARE DELIVERY SYSTEM

MARIA CONCEPCION GUIA-SUAREZ, RN,MAN

LECTURER
 OBJECTIVES:
At the end of lecture the students will:
• Define WHO and DOH
• Describe the Philippine health care delivery system
in terms of the different levels of services.
• Explain how the Department of Health (DOH)
provides health leadership in the Philippines.
• Elucidate on the functions of the members of the
health team in the rural health unit health center.
• Differentiate the referral system from the interlocal
health zone.
 WORLD HEALTH ORGANIZATION (WHO)
• A specialized agency of the United Nations provides global leadership on
health matters

BRIEF HISTORY:
• April 7, 1948- Creation of WHO
• Headquarters in Geneva, Switzerland
• 147 country offices
• 6 World Regional Regional Offices
Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia,
and the Western Pacific.
 MILLENIUM DEVELOPMENT GOALS (MDGs)
by the year 2015 (UN, 2013)- PHILIPPINES
The following are the eight MDGs and the targets corresponding to health-related MDGs 4, 5, and 6 (UN, 2008):
1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education.

3. Promote gender equality and empower women.

4. Reduce child mortality. Target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
5. Improve Maternal Health.
Targets:
a. Reduce by three-quarters the maternal mortality ratio; and
b. Achieve universal access to reproductive health.
6. Combat HIV/AIDS, Malaria, and Other Diseases.
Targets:
a. Have halted by 2015 and begun to reverse the spread of HIV/AIDS;
b. Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it; and
c. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases.
7. Ensure environmental sustainability.
8. Develop a global partnership for development.

of the eight MDGs, five are not considered as strictly health issues. However, these five MDGs are health-related issues because they are goals toward upgrading
socioeconomic conditions. These socioeconomic conditions are, in themselves, health determinants.
 DEPARTMENT OF HEALTH (DOH)
EXECUTIVE ORDER 102
• Provides leadership at the national level
• Provides guidance and technical assistance to LGUs through the Center
for Health Development in each of the 17 regions.

MAJOR ROLES
(1) Leader in Health
(2) Enabler and Capacity Builder
(3) Administrator of Specific Services

CORE VALUES
(1) Integrity
(2) Excellence,
(3) Compassion and Respect for Human Dignity,
(4) Commitment
(5) Professionalism,
(6) Teamwork,
(7) Stewardship of the health of the people
 RA 7160 LOCAL GOVERNMENT CODE
• Genuine and meaningful local autonomy.
• Enable local governments to attain their fullest development as self-reliant communities and make them more effective
partners in the attainment of national goals.
• This was provided for the creation of Provincial Health Board and City/Municipal Health Board, or the Local Health
Boards
THE FUNCTIONS OF LOCAL HEALTH BOARDS ARE AS FOLLOWS:
1. Proposing to the Sanggunian annual budgetary allocations for the operation and maintenance of health facilities and services within
the province/city/ municipality;
2. Serving as an advisory committee to the Sanggunian on health matters; and
3. Creating committees that shall advise local health agencies on various matters related to health service operations.

PROVINCIAL GOVERNMENTS
• responsible for the administration of provincial and district hospitals.

MUNICIPAL AND CITY GOVERNMENTS

• in charge of primary care through rural health units (RHUs) or health centers. Satellite outposts known as barangay health stations
(BHSs) provide health services in the periphery of the municipality or city.

SATELLITE OUTPOSTS KNOWN AS BARANGAY HEALTH STATIONS (BHSS)

• provide health services in the periphery of the municipality or city.
LEVELS OF HEALTH CARE DELIVERY
AO 2012-0012 (Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines)
HOSPITALS OTHER HEALTH FACILITIES DESCRIPTION
GENERAL A. PRIMARY HEALTH CARE FIRST CONTACT FACILITY AND OFFERS BASIC SERVICES
SERVICES FOR ALL KINDS OF EMERGENCY SERVICES AND DELIVERY SERVICES
ILLNESSES, INJURIES, AND 1. Without in-patient: health centers, dental and clinics
DEFORMITIES 2. With in-patient: with short stays like infirmaries and birthing facility

B. CUSTODIAL FACILITY A HEALTH FACILITY THAT PROVIDES LONG-TERM CARE, INCLUDING BASIC SERVICES
• LEVEL 1 LIKE FOOD AND SHELTER, TO PATIENTS WITH CHRONIC CONDITIONS REQUIRING
• LEVEL 2 ONGOING HEALTH AND NURSING CARE DUE TO IMPAIRMENT AND A REDUCED
• LEVEL 3 (Teaching/ DEGREE OF INDEPENDENCE IN ACTIVITIES OF DAILY LIVING, AND PATIENTS IN NEED
Training) OF REHABILITATION:
1. Custodial Psychiatric Facilities, Substance/Drug Abuse Tx & Rehab. Center
2. Sanitaria/Leprosaria, and
3. Nursing Homes

C. DIAGNOSTIC/ THERAPEUTIC DIAGNOSTIC/ THERAPEUTIC FACILITY - A FACILITY FOR THE EXAMINATION OF THE
HUMAN BODY, SPECIMENS FROM THE HUMAN BODY FOR THE DIAGNOSIS, SOMETIMES
FACILITY TREATMENT OF DISEASE, OR WATER FOR DRINKING WATER ANALYSIS.THE TEST COVERS
THE PREANALYTICAL, ANALYTICAL, AND POSTANALYTICAL PHASES OF EXAMINATION.
THIS CATEGORY IS FURTHER CLASSIFIED INTO:
1. Laboratory Facility
2. Radiologic Facility
3. Nuclear Medicine Facility

SPECIALTY D. SPECIALIZED OUTPATIENT FACILITY THAT PERFORMS HIGHLY SPECIALIZED PROCEDURES ON AN

OUTPATIENT BASIS.
FACILITY 1. Dialysis Clinic,
2. Ambulatory Surgical Clinic,
3. Cancer Chemotherapeutic Center/Clinic, Cancer Radiation Facility and
4. Physical Medicine and Rehabilitation Center/Clinic.
 THE RURAL HEALTH UNIT
• The Rural Health Unit (RHU), commonly known as a health center, is a primary level
health facility in the municipality.
• The focus of the RHU is preventive and promotive health services and the supervision
of BHSs under its jurisdiction (DOH, 2001).
• The recommended ratio of RHU to catchment population is 1 RHU:20,000 population
(DOH, 2009).
• The BHS is the first-contact healthcare facility that offers basic services at the barangay
level.
• It is a satellite station of the RHU.
• It is manned by the volunteer Barangay Health Workers (BHWs) under the supervision of
the Rural Health Midwife (RHM)
 The Rural Health Unit Personnel
THE MUNICIPAL HEALTH OFFICER (MHO) OR RURAL HEALTH PHYSICIAN
heads the health services at the municipal level and carries out the following roles and functions:
RATIO- 1: 20,000
1. ADMINISTRATOR OF THE RHU
a. Prepares the municipal health plan and budget
b. Monitors the implementation of basic health services
c. Management of the RHU staff
2. COMMUNITY PHYSICIAN
a. Conducts epidemiological studies
b. Formulates health education campaigns on disease prevention
c. Prepares and implements control measures or rehabilitation plans
3. MEDICO-LEGAL OFFICER OF THE MUNICIPALITY

THE PUBLIC HEALTH NURSE (PHN)

RATIO- 1: 20,000
1. Supervises and guides all RHMs in the municipality (DOH, 2001);
2. Prepares the FHSIS quarterly and annual reports of the municipality for submission to the Provincial Health Office;
3. Utilizes the nursing process in responding to health care needs, including needs for health education and promotions
of individuals, families, and catchment communities; and
1. Collaborates with the other members of the health team, government agencies, private businesses, NGOs, and people's
organizations to address the community's health problems.

REVISED IMPLEMENTING RULES AND REGULATIONS (IRRS) OF R.A. 7305 OR THE MAGNA CARTA OF PUBLIC HEALTH WORKERS STIPULATE THAT RATIO
 The Rural Health Unit Personnel
THE RURAL HEALTH MIDWIFE (RHM)
1.Manages the BHS and supervises and trains the BHW;
2.Provides midwifery services and executes health care programs and activities for women of reproductive
age, including family planning counseling and services;
3.Conducts patient assessment and diagnosis for referral or further management;
4.Performs health information, education, and communication activities;
5.Organizes the community; and
6.Facilitates barangay health planning and other community health services (DOH)

RURAL SANITATION INSPECTOR ((SI)

are directed towards ensuring a healthy physical environment in the municipality. This entails
advocacy, monitoring, and regulatory activities, such as inspection of water supply and unhygienic
household conditions.

BARANGAY HEALTH WORKERS (BHWs)

are considered as the interface between the community and the RHU. They are trained in preventive
health care, with a strong emphasis on maternal and child care, family planning and reproductive health,
nutrition, and sanitation. They are also equipped with basic skills for prevention and management of
common diseases.
 THE REFERRAL SYSTEM
• A referral is a set of activities undertaken by a healthcare provider or facility in response to its inability to provide the
necessary health intervention to satisfy a patient's need.
• A functional referral system is one that ensures the continuity and complementation of health and medical services.
• It is comprehensive, encompassing promotive, preventive, curative, and rehabilitative care.
• It engages all health facilities from the lowest to the highest level.
• It usually involves the movement of a patient from the health center of first contact and the hospital at first referral level.
When hospital intervention has been completed, the patient is referred back to the health center. This accounts for the
term two-way referral system

2 TYPES OF REFERRAL
INTERNAL EXTERNAL

Internal referrals occur within the health facility,
from one health personnel to another.
Ex. of internal referral are RHM to PHN and PHN to
MHO. An internal referral may be made to request
for an opinion or suggestion, co-management, or
further management of specialty care.
An external referral is a movement of a patient
from one health facility to another.
• It may be vertical, where the patient referral
may be from a lower to a higher level of
health or the other way around.
• The referral may also be horizontal where the
patient is referred between similar facilities in
different catchment areas.
 THE INTER-LOCAL HEALTH ZONE
The ILHZ is based on the concept of the District Health System, a generic term used by WHO to describe an
integrated health management and delivery system based on a defined administrative and geographical area.

The ILHZ has the following components (DOH, 2002):

• People- Although WHO has described the ideal population size of a health district between 100,000
and 500,000, the number of people may vary from zone to zone, especially when taking into
consideration the number of LGUs that will decide to cooperate and cluster.

• Boundaries- Clear boundaries between ILHZs establish accountability and responsibility of health
service providers.

• Health facilities- RHUs, BHSs, and other health facilities that decide to work together as an integrated
health system and a district or provincial hospital, serving as the central referral hospital, make up the
health facilities of an ILHZ.

• Health workers - To deliver comprehensive services, the ILHZ health workers include personnel of
the DOH, district or provincial hospitals, RHUs, BHSs, private clinics, volunteer health workers from
NGOs, and community-based organizations.
DID YOU LEARN SOMETHING?
I HOPE YOU DID!

THANK YOU!
 TEXTBOOKS AND REFERENCE MATERIALS:

q DOH. (n.d.). Integrated management of childhood illness program. Department of Health website.
https://doh.gov.ph/integrated-management-of-childhood-illness

q Naomi E. Ervin, P., & Pamela Kulbok, A. (2018). Advanced public and community health nursing
practice 2e: Population assessment, program planning and evaluation. Springer Publishing
Company.

q Nies, M. A., McEwen, M., & Sumile, E. A. (2020). Community and Public Health Nursing, Philippine
Edition.

q Zenaida U. Famorca, Mary A. Nies, Melanie McEwan, A. M. (2019). Nursing Care of the Community: A
Comprehensive Text on Community and Public Health (Philippine Edition 7th ed.).