THE PHILIPPINE HEALTH CARE DELIVERY The Philippine Health Care Delivery System

SYSTEM
Health is a basic human right guaranteed by the
INTRODUCTION Philippine Constitution of 1987. This is provided in
Health care system is an organized plan of health the Philippines through a dual health delivery
system composed of the public sector and the
services. The rendering of health care services to
private sector. The public sector is largely financed
the people is called health care delivery system.
through a tax-based budgeting system, where
Thus, health care delivery system is the network of
health services are delivered by government
health facilities and personnel which carries out the
facilities under the national and local governments.
task of rendering health care to the people. In the
Philippines health care system is complex set of The Philippine health care system has rapidly
organizations interacting to provide an array of evolved with many challenges through time.
health services. Health service delivery was devolved to the Local
Government Units (LGUs) in 1991, and for many
The National Health Situation (Philippine Health
reasons, it has not completely surmounted the
Situation)
fragmentation issue. Health human resource
struggles with the problems of underemployment,
The Philippines has made significant investments
scarcity and skewed distribution. There is a strong
and advances in health in recent years. Rapid
involvement of the private sector comprising 50%
economic growth and strong country capacity have
of the health system but regulatory functions of the
contributed to Filipinos living longer and healthier.
government have yet to be fully maximized.
However, not all the benefits of this growth have
reached the most vulnerable groups, and the health
The Department of Health (DOH) supervises the
system remains fragmented. Health insurance now
government corporate hospitals, specialty and
covers 92% of the population.
regional hospitals, while the Department of National
Defense runs the military hospitals. At the local
Maternal and child health services have improved,
level, the provincial governments manage and
with more children living beyond infancy, a higher
operate district and provincial hospitals, while
number of women delivering at health facilities and
municipal governments provide primary care,
more births being attended by professional service
including preventive and promotive health services
providers than ever before. Access to and provision
and other public health programmes through the
of preventive, diagnostic and treatment services for
rural health units, health centers and barangay
communicable diseases have improved, while there
health stations.
are several initiatives to reduce illness and death
due to non-communicable diseases (NCDs).
Highly urbanized and independent cities provide
both hospital services and primary care services.
Despite substantial progress in improving the lives
The private sector, consisting of for-profit and non-
and health of people in the Philippines,
profit health-care providers, is largely market
achievements have not been uniform and
oriented, where health care is generally paid for
challenges remain. Deep inequities persist between
through user fees at the point of service. The
regions, rich and the poor, and different population
introduction of social health insurance
groups. Many Filipinos continue to die or suffer
administered by the Philippine Health Insurance
from illnesses that have well-proven, cost-effective
Corporation (PhilHealth) since 1995 aimed to provide
interventions, such tuberculosis, HIV and dengue,
financial risk protection for the Filipino people. The
or diseases affecting mothers and children.
rapid expansion of its membership in the past 5
Many people lack sufficient knowledge to make
years is considered a positive development as the
informed decisions about their own health. Rapid
Government pursues universal health coverage.
economic development, urbanization, escalating
climate change, and widening exposure to diseases
Health Financing
and pathogens in an increasingly global world
increase the risks associate with disasters,
Health financing refers to how financial resources
environmental threats, and emerging and re-
are used to ensure that the health system can
emerging infections.
adequately cover the collective health needs of
every person. It is a cornerstone of the overall
health system and can greatly impact the quality
and access to health services. It is a foundational
component that impacts the entire health system’s
performance, including the delivery and
accessibility of primary health care.
Health financing policy focuses on mobilizing and
pooling financial resources and allocating them to
health care providers (purchasing) in an equitable
and efficient way. This will enable provision of
essential health services of good quality to all,
especially to the poorer communities, and in
populations in rural areas.
The Philippines’s (THE) has consistently increased
since 2005 and compares well with neighbors like
Indonesia. Government health expenditure has
increased significantly in nominal terms, but it has
been eclipsed by private sector funding sources,
which have grown rapidly with the economy.
Much of Total health expenditure is for personal
care, although the Government has raised spending
on public health since 2007. The three major flows
of public health financing have overlapping
coverage. The DOH funds regional and apex hospitals,
while local government units (LGUs) fund primary-
and secondary-level care.
PhilHealth reimburses government as well as
private health facilities. It reportedly covers 92% of
the population, 40% of which is the poor
population and subsidized by the Government for
premium payments. Covered services are focused on
inpatient care and inadequate outpatient care that only
covers the poor members of PhilHealth.
Health Facilities
Health facilities in the Philippines include
government hospitals, private hospitals and primary
health care facilities. Hospitals are classified based on
ownership as public or private hospitals. In the
Philippines, around 40 percent of hospitals are
public (Department of Health, 2009). Out of 721
public hospitals, 70 are managed by the DOH while
the remaining hospitals are managed by LGUs and
other national government agencies (Department of
Health, 2009). Both public and private hospitals can
also be classified by the service capability. A new
classification and licensing system will soon be
adopted to respond to the capacity gaps of existing
health facilities in all levels. At present, Level-1
hospitals account for almost 56 percent of the total
number of hospitals which have very limited
capacity, comparable only to infirmaries.
The number of hospital beds is also a good indicator of
health service availability. Per WHO
recommendation, there should be 20 hospital beds
per 10,000 population. Almost all regions have
insufficient beds relative to the population except
for NCR, Northern Mindanao, Southern Mindanao
and CAR. Among the seventeen regions,
Autonomous Region for Muslim Mindanao
(ARMM) has the lowest bed to populationratio
(0.17 beds per 1000 population), far lower than the
national average
In terms of physical infrastructure, the Philippine
health sector has 1224 hospitals, 2587 city/rural
health centres and 20 216 village health stations.
Sixty-four per cent of hospitals are Level 1 non-
departmental hospitals with an average capacity of
41 beds, and 10% are Level 3 medical centres and
teaching hospitals, with an average capacity of 318
beds.
The private sector’s share of total hospital beds
increased from 46% in 2003 to 53% in 2016. The
geographical distribution of these resources varies
within the country. Almost two thirds of hospital
beds are in the island of Luzon, which includes the
National Capital Region (NCR). There are 23
hospital beds for 10 000 people in the NCR while
the rest of Luzon, Visayas and Mindanao have only
8.2, 7.8 and 8.3 beds, respectively. Operating
indicators vary between public and private
hospitals. The average bed occupancy rate of public
medical centres is significantly higher than for
private hospitals. On average, patients stay about two
days longer in public than in private medical centres.
Health Human Resource
The health human resources are the main drivers of
the health care system and are essential for the
efficient management and operation of the public
health system. They are the health educators and
providers of health services. The Philippines has a
huge human reservoir for health. However, they
are unevenly distributed in the country. Most are
concentrated in urban areas such as Metro Manila
and other cities.
In terms of human resources for health, the top four
forces of institution-based health workers are nurses
(90 308), doctors (40 775), midwives (43 044) and
medical technologists (13 413) (2017 figures). The
public sector engages a higher proportion of nurses
(61%), midwives (91%) and medical technologists
(53%). There are also marked differences in the
number of institution-employed health workers
available to serve area populations. The density of
nurses per 10 000 population is highest in the NCR
at 12.6 and lowest in the ARMM at 4.2.
The first point of contact for government-provided
health services is the health centre and its satellite
village health station(s), which typically employs an
average of one doctor, two nurses and five
midwives
Utilization of Health Facilities
In the recent National Demographic and Health
Survey (NDHS), 50 percent of the clients who
sought medical advice or treatment consulted
public health facilities, 42 percent went to private
health facilities, and almost 7 percent sought
alternative or traditional health care. Rural Health
Units (RHUs) and Barangay Health Centers (33
percent) were the most visited health facilities in
almost all the regions except for NCR and CAR,
where most of the clients visited private
hospital/clinic for medical advice or treatment.
The most common reasons for seeking health care
were illness or injury (68 percent), medical checkup
(28 percent), dental care (2 percent), and medical
requirement (1 percent) (NSO, 2008).
The hospital sector in the Philippines is highly
segmented in nature. Utilization of hospitals may
be driven by PhilHealth insurance coverage and
socio-economic determinants. People with
PhilHealth insurance are more likely to be confined
in a private hospital, than those without Philhealth
insurance . Similarly, patients living in urban area
and belonging to the richest quintile are also more
likely to be confined in private hospitals (Lavado et
al., 2010)
Available data shows that on the average, travel
time to a health facility is 39 minutes; where travel
time is longest in ARMM which is 83 minutes and
shortest in NCR and Northern Mindanao, 28
minutes. Travel time is relatively longer in rural
areas than in urban areas ; and longest for persons
in the lowest wealth quintile and shortest for those
in the highest wealth quintile. Older persons
seeking care (60+ years old) have longer average
travel times than younger persons (National
Statistics Office, 2008)
Satisfaction with Health Facilities
Based on a survey by the Social Weather Station in
2006, majority of Filipinos specifically the low
income households prefer to seek treatment in a
government hospital if a family member needs
confinement. Affordability is the main reason for
going to a government medical facility, while
excellent service is the main reason for going to a
private medical facility (Department of Health,
2010).
Excellent service and affordability are the main
reasons for being satisfied whereas poor service is
the main reason for being dissatisfied with the
services given by government hospitals (Social
Weather Stations, 2006)
Health Governance and Regulation
As the national technical authority on health, the
DOH provides national policy direction and strategic
plans, regulatory services, standards and guidelines for
health, and highly specialized and specific tertiary-level
hospital services. It provides leadership, technical
assistance, capacitybuilding, linkages and
coordination with other national government
agencies, LGUs and private entities in
implementing health policies.
The LGUs, i.e. provincial, city and municipal
governments, on the other hand, are responsible for
managing and implementing local health
programmes and services. A local health board
chaired by the local chief executive (governor or
mayor) serves as an advisory body to the local chief
executives and the local legislative council
members (sanggunian) on the local health system,
while the DOH Regional Health Office is
represented by either a DOH representative or
Development Management Officer under the DOH
Provincial Health Team.
In Mindanao, a distinct subnational entity called
the Autonomous Region in Muslim Mindanao
(ARMM) was created by Republic Act No. 6734, as
amended by Republic Act No. 9054. ARMM
consists of five provinces and has its own regional
Department of Health that is directly responsible to
the ARMM Regional Governor. It directly
administers the provincial, city and municipal
health offices, and the provincial and district
hospitals within the autonomous region.
Health Policies and Systems
The Government’s vision for the Philippines has
been translated by the Department of Health into
the Philippine Health Agenda 2016–2022. Under the
motto All for Health Towards Health for All, universal
health coverage is the platform for health and
development in the Philippines –driven by action
within and outside the health sector. Reducing
health inequities is singled out as the most important
result of three health guarantees: (a) ensuring
financial protection for the poorest people; (b)
improving health outcomes with no disparities;
and (c) building health service delivery networks
for more responsiveness
 Health Outcomes
The projected average life expectancy of Filipinos
in 2005 to 2010 is 68.8 years, with males having an
average life expectancy of 66.11 years and females
with 71.64 years (National Statistics Office, 2010). It
is projected that the average life expectancy of
Filipinos will increase to 70.38 years from 2010 to
2015 and 71.59 years from 2015 to 2020 (National
Statistics Office).
HEALTH REFORM INITIATIVES IN THE
PHILIPPINES
Health reforms in the Philippines build upon the
lessons and experiences from the past major health
reform initiatives undertaken in the last 30 years.
The adoption of primary health care (PHC)
approach in 1979 promoted participatory
management of the local health care system. The
goal was to achieve health for all Filipinos by the
year 2000. It emphasized the delivery of eight
essential elements of health care, including:
1. Prevention and control of prevalent health
problems
2. Promotion of adequate food supply and
proper nutrition
3. Basic sanitation and adequate supply of
water
4. Maternal and child care
5. Mmmunization
6. Prevention and control of endemic diseases
7. Appropriate treatment and control of
common diseases; and
8. Provision of essential drugs.
To implement PHC, EO 851 was issued in 1983
integrating public health and hospital services
(World Health Organization, 2011).
The People Power Revolution strengthened the call
for legitimate local representation. In early 1990s,
RA 7160 or the Local Government Code (LGC)
transferred the responsibility of health service
provision to the local government units. The
intention of LGC was to establish a more
responsive and accountable local government
structure. However, this has resulted to
fragmentation of administrative control of health
services between the rural health units and
hospitals and between the different levels of
political structure (World Health Organization,
2011). Prior to that, the Generics Act was adopted
in 1988 to ensure adequate supply, distribution and
use of generics thereby improving access to
affordable drugs and medicines.
During that time, more than half of the population
had no coverage, especially the poor, the self-
employed and informal sector workers (World
Health Organization, 2011). This led to the
enactment of the National Health Insurance Act of
1995 or RA 9875 which aims to provide all citizens
a mechanism for financial protection with priority
given to the poor. It created the National Health
Insurance Program “which shall provide health
insurance coverage and ensure affordable,
acceptable, available and accessible health services
for all citizens of the Philippines.” In 1999, the
Health Sector Reform Agenda was launched as a
major policy framework and strategy to improve
the way health care is delivered, regulated and
financed. With a battle cry of “Kalusugan Para sa
Masa”, it was designed to implement the reform
package in the convergence sites.
The five reform areas are:
1. Public health
2. Hospital;
3. Local health systems;
4. Health regulations and
5. Health financing
It was during this time that the DOH underwent a
major organizational reform to pursue its new role
as a result of the devolution. At the local level, the
municipalities were joined together to form
Interlocal Health Zones (ILHZs) to optimize
sharing of resources and maximize joint benefits
from local health initiatives. The operational
framework of health sector reforms was adopted in
2005 and was called FOURmula One for Health
(F1). The objective was to undertake critical reforms
with speed, precision and effective coordination
directed at improving the efficiency, effectiveness
and equity of the Philippine health system in a
manner that is felt by the Filipinos especially the
poor.
The F1 organized health reform initiatives into four
implementation components, namely:
1. financing, regulation
2. service delivery and
3. governance
This time also marked the enactment of two pieces
of legislation; the
1. Universally Accessible Cheaper and Quality
Medicines Act of 2008
2. Food and Drug Administration Act of 2009.
However, despite the important progress made,
successive reforms have not succeeded in
adequately addressing the persistent problem of
inequity.
 UNIVERSAL HEALTH CARE (UHC) TO
ADDRESS INEQUITY IN THE HEALTH
SYSTEM
Universal Health Care and Its Aim
Universal Health Care (UHC), also referred to as
Kalusugan Pangkalahatan (KP), is the “provision to
every Filipino of the highest possible quality of
health care that is accessible, efficient, equitably
distributed, adequately funded, fairly financed, and
appropriately used by an informed and
empowered public”.The Aquino administration
puts it as the availability and accessibility of health
services and necessities for all Filipinos.
It is a government mandate aiming to ensure that
every Filipino shall receive affordable and quality
health benefits. This involves providing adequate
resources – health human resources, health
facilities, and health financing.
UHC’s Three Thrusts
To attain UHC, three strategic thrusts are to be
pursued, namely: 1) Financial risk protection
through expansion in enrolment and benefit
delivery of the National Health Insurance Program
(NHIP); 2) Improved access to quality hospitals and
health care facilities; and 3) Attainment of health-
related Millennium Development Goals (MDGs).
1. Financial Risk Protection
Protection from the financial impacts of
health care is attained by making any
Filipino eligible to enroll, to know their
entitlements and responsibilities, to avail of
health services, and to be reimbursed by
PhilHealth with regard to health care
expenditures.
PhilHealth operations are to be redirected
towards enhancing national and regional
health insurance system. The NHIP
enrollment shall be rapidly expanded to
improve population coverage. The
availment of outpatient and inpatient
services shall be intensively promoted.
Moreover, the use of information
technology shall be maximized to speed up
PhilHealth claims processing.
2. Improved Access to Quality Hospitals and
Health Care Facilities
Improved access to quality hospitals and
health facilities shall be achieved in a
number of creative approaches. First, the
quality of government-owned and operated
hospitals and health facilities is to be
upgraded to accommodate larger capacity,
to attend to all types of emergencies, and to
handle non-communicable diseases. The
Health Facility Enhancement Program
(HFEP) shall provide funds to improve
facility preparedness for trauma and other
emergencies. The aim of HFEP was to
upgrade 20% of DOH-retained hospitals,
46% of provincial hospitals, 46% of district
hospitals, and 51% of rural health units
(RHUs) by end of 2011.
Financial efforts shall be provided to allow
immediate rehabilitation and construction
of critical health facilities. In addition to
that, treatment packs for hypertension and
diabetes shall be obtained and distributed to
RHUs.
The DOH licensure and PhilHealth
accreditation for hospitals and health
facilities shall be streamlined and unified.
3. Attainment of Health-related MDGs
Further efforts and additional resources are
to be applied on public health programs to
reduce maternal and child mortality,
morbidity and mortality from Tuberculosis
and Malaria, and incidence of HIV/AIDS.
Localities shall be prepared for the
emerging disease trends, as well as the
prevention and control of non-
communicable diseases.
The organization of Community Health
Teams (CHTs) in each priority population
area is one way to achieve health-related
MDGs. CHTs are groups of volunteers, who
will assist families with their health needs,
provide health information, and facilitate
communication with other health providers.
RNheals nurses will be trained to become
trainers and supervisors to coordinate with
community-level workers and CHTs. By the
end of 2011, it is targeted that there will be
20,000 CHTs and 10,000 RNheals.
Another effort will be the provision of
necessary services using the life cycle
approach. These services include family
planning, ante-natal care, delivery in health
facilities, newborn care, and the
Garantisadong Pambata package.
 Better coordination among government
agencies, such as DOH, DepEd, DSWD, and
DILG, would also be essential for the
achievement of these MDGs.
PHILIPPINE HEALTH AGENDA 2016-2022
Under the Duterte Administration a health reform
initiative “All for Health Towards Health for All"
was created. This is the battle cry of the Philippine
Heath Agenda 2016-2022 for a Healthy Philippines
2022 which aims to ensure the best health outcome
for all Filipinos, regardless of socio-economic class,
ethnicity, gender, and geographic location.
 Devolution of health care services from
national to local government
 Use of Generics
 Milk Code
 PhilHealth (1995)
 DOH resources to promote local health
system development
 Fiscal autonomy for government hospitals
 Good governance programs
 Funding for Universal Health Care (UHC)
Persistent Inequities in Health Outcomes
 Every year, around 2000 mothers die due to
pregnancy-related complications.
 A Filipino child born to the poorest family
is 3 times more likely to not reach his 5th
birthday, compared to one born to the
richest family
 Three out of 10 children are stunted.

Restrictive and Impoverishing Healthcare Costs

 Every year, 1.5 million families are pushed
to poverty due to health care expenditures
 Filipinos forego or delay care due to
prohibitive and unpredictable user fees or
co-payments
GOALS
 Php 4,000/month healthcare expenses
considered catastrophic for single income
1. FINANCIAL PROTECTION
families
 Filipinos, especially the poor,
Poor quality and undignified care synonymous
marginalized, and vulnerable are
with public clinics and hospitals
protected from high cost of health
 Long wait times
care
 Limited autonomy to choose health care
provider
2. BETTER HEALTH OUTCOMES
 Less than hygienic restrooms, lacking
 Filipinos attain the best possible
amenities
health outcomes with no disparity
 Privacy and confidentiality taken lightly
 Poor record-keeping
3. RESPONSIVENESS
 Overcrowding and under provision of care
 Filipinos feel respected, valued, and
empowered in all of their interaction
To address these health problems and inequalities,
with the health system
the government under the administration of
president Duterte created “ALL FOR HEALTH
VALUES
TOWARDS HEALTH FOR ALL (Lahat Para sa
Kalusugan! Tungo sa Kalusugan Para sa Lahat) a
 Equitable & inclusive to all
health reform initiative which focusses on universal
 Transparent & accountable
health coverage, strengthening implementation of
 Uses resources efficiently
RPRH law, war on drugs and additional funds
 Provides high quality services
from PAGCOR.
During the last 30 years of Health Sector Reform,
The main goal of Health Reform Agenda 2016-2022
the government has undertaken key structural
is to attain health-related SDG targets and
reforms and continuously built on programs that
specifically aims to achieve financial risk
take us a step closer to our aspiration. The
Protection, better health Outcomes and
milestones in the Health Sector Reform during the
responsiveness to the health care needs of the
last years include:
Filipinos. To attain these goals, the health reform
agenda is guided with values such as equity,
quality, efficiency, transparency, accountability,
sustainability and resilience.
The health reform agenda 2016-2022 assures three
GUARANTEES for the Filipino utilizing strategies
( the acronym ACHIEVE) in order to achieve the
goals of the health agenda.
The Three health GUARANTEES are:
GUARANTEE #1: ALL LIFE STAGES & TRIPLE
BURDEN OF DISEASE (Services for Both the
Well & the Sick across all stages of life from
pregnancy to elderly). These services include:
1. First 1000 days
2. Reproductive and sexual health
3. Maternal, newborn, and child health
4. Exclusive breastfeeding
5. Food & micronutrient
supplementation
6. Immunization
7. Adolescent health
8. Geriatric Health
9. Health screening, promotion &
information
1. Communicable diseases
o HIV/AIDS
o TB
o Malaria
o Diseases for Elimination : Dengue,
Leptospirosis, Ebola, Zika
2. Non-communicable diseases & malnutrition
o Cancer
o Diabetes
o Heart Disease and their Risk Factors
– obesity, smoking, diet, sedentary
lifestyle
o Malnutrition
3. Diseases of rapid urbanization &
industrialization
o Injuries
o Substance abuse
o Mental Illness
o Pandemics, Travel Medicine
o Health consequences of climate
change / disaster
GUARANTEE #2: SERVICE DELIVERY
NETWORK (Functional Network of Health
Facilities)
Services are delivered by networks that are:
 Fully functional (Complete Equipment,
Medicines, Health Professional)
 Compliant with clinical practice guidelines
 Available 24/7 & even during disasters
 Practicing gatekeeping
 Located close to the people (Mobile Clinic
or SubsidizeTransportation Cost)
 Enhanced by telemedicine
GUARANTEE #3 UNIVERSAL HEALTH
INSURANCE (Financial Freedom when Accessing
Services). Services are financed predominantly by
PhilHealth.
A. Philhealth as the gateway to free affordable care
 100% of Filipinos are members
 Formal sector premium paid through
payroll
 Non-formal sector premium paid through
tax subsidy
B. Simplify Philhealthe rules
 No balance billing for the poor/basic
accommodation & Fixed co-payment for
non-basic accommodation
C. Phi health as main revenue source for public
health care providers
 Expand benefits to cover comprehensive
range of services
 Contracting networks of providers within
service delivery networks (SDNs)
STRATEGY
To attain the goal of the Health Reform Agenda
2016-2022, the following strategies are put in place.
A - Advance quality, health promotion and
primary care
C - Cover all Filipinos against health-related
financial risk
H - Harness the power of strategic HRH
development
I - Invest in eHealth and data for decision-making
E - Enforce standards, accountability and
transparency
V -Value all clients and patients, especially the
poor, marginalized, and vulnerable
E - Elicit multi-sectoral and multi-stakeholder
support for health
1. Advance quality, health promotion and
primary care
o Conduct annual health visits for all poor
families and special populations (NHTS, IP,
PWD, Senior Citizens)
o Develop an explicit list of primary care
entitlements that will become the basis for
licensing and contracting arrangements
 o Transform select DOH hospitals into mega-
hospitals with capabilities for multi-specialty
training and teaching and reference laboratory
o Support LGUs in advancing pro-health
resolutions or ordinances (e.g. city-wide
smoke-free or speed limit ordinances)
o Establish expert bodies for health promotion
and surveillance and response
2. Cover all Filipinos against health-related
financial risk
o Raise more revenues for health, e.g. impose
healthpromoting taxes, increase NHIP
premium rates, improve premium collection
efficiency.
o Align GSIS, MAP, PCSO, PAGCOR and
minimize overlaps with PhilHealth
o Expand PhilHealth benefits to cover
outpatient diagnostics, medicines, blood and
blood products aided by health technology
assessment
o Update costing of current PhilHealth case
rates to ensure that it covers full cost of care
and link payment to service quality
o Enhance and enforce PhilHealth contracting
policies for better viability and sustainability
3. Harness the power of strategic HRH
(Human Resource for Health) development
o Revise health professions curriculum to be
more primary care-oriented and responsive to
local and global needs
o Streamline HRH compensation package to
incentivize service in high-risk or
geographically isolated and disadvantaged
areas (GIDA)
o Update frontline staffing complement
standards from profession-based to
competency-based
o Make available fully-funded scholarships for
HRH hailing from GIDA areas or IP groups
o Formulate mechanisms for mandatory return
of service schemes for all heath graduates
4. Invest in eHealth and data for decision-
making
o Mandate the use of electronic medical records
in all health facilities
o Make online submission of clinical, drug
dispensing, administrative and financial
records a prerequisite for registration, licensing
and contracting
o Commission nationwide surveys, streamline
information systems, and support efforts to
improve local civil registration and vital
statistics
o Automate major business processes and invest
in warehousing and business intelligence tools
o Facilitate ease of access of researchers to
available data
5. Enforce standards, accountability and
transparency
o Publish health information that can trigger
better performance and accountability
o Set up dedicated performance monitoring
unit to track performance or progress of
reforms
6. Value all clients and patients, especially
the poor, marginalized, and vulnerable
o Prioritize the poorest 20 million
Filipinos in all health programs and
support them in non-direct health
expenditures
o Make all health entitlements simple,
explicit and widely published to
facilitate understanding, & generate
demand
o Set up participation and redress
mechanisms
o Reduce turnaround time and
improve transparency of processes
at all DOH health facilities
o Eliminate queuing, guarantee decent
accommodation and clean restrooms
in all government hospitals
7. Elicit multi-sectoral and multi-stakeholder
support for health
o Harness and align the private sector in
planning supply side investments
o Work with other national government agencies
to address social determinants of health
o Make health impact assessment and public
health management plan a prerequisite for
initiating large-scale, high-risk infrastructure
projects
o Collaborate with Civil Service Organizations
(CSOs) and other stakeholders on budget
development, monitoring and evaluation
 THE NATIONAL OBJECTIVES FOR HEALTH
(NOH)
The National Objectives for Health (NOH) 2017–
2022 serves as the medium-term roadmap of the
Philippines towards achieving universal healthcare
(UHC). It specifies the objectives, strategies and
targets of the Department of Health (DOH)
FOURmula One Plus for Health (F1 Plus for
Health) built along the health system pillars of
financing, service delivery, regulation, governance
and performance accountability. This ultimately
leads to the three major goals that the Philippine
Health Agenda aspires for: (1) better health
outcomes with no major disparity among
population groups; (2) financial risk protection for
all especially the poor, marginalized and
vulnerable; and (3) a responsive health system
which makes Filipinos feel respected, valued and
empowered.
In response to the challenges identified in
improving health outcomes and the health system,
the DOH pursues FOURmula One Plus (F1 Plus)
for Health, which aims to provide Universal Health
Care (UHC) for all Filipinos in the medium to long
term. The national policy on UHC espouses three
strategic thrusts: better health outcomes, responsive
health system, and equitable and sustainable health
financing
F1 Plus for Health has three strategic goals:
Strategic Goal 1: Better health outcomes
o The health sector will sustain gains and
address new challenges especially in
maternal, newborn and child health,
nutrition, communicable disease
elimination, and Non-Communicable
Disease (NDC) prevention and treatment.
o Improvements in health outcomes will be
measured through sentinel indicators such
as life expectancy, maternal and infant
mortalities, NCD mortalities, TB incidence,
and stunting among under-five year-olds.
Strategic Goal 2: More Responsive Health System
o The quality of health goods and services as
well as the manner in which they are
delivered to the population will be
improved to ensure people-centered
healthcare provision.
o This may be done through instruments that
routinely monitor and evaluate client
feedback on health goods used and services
received.
Strategic Goal 3: More equitable Healthcare
Financing
o Access of Filipinos, especially the poor and
underserved, to affordable and quality
health goods and services will be expanded
through mechanisms that provide them
with adequate financial risk protection from
the high and unpredictable cost of
healthcare.
o These may include efforts to reduce
catastrophic out of the pocket (OOP)
payments, such as through public subsidies
targeted towards the poor
The priorities of F1 Plus for Health hew closely to
the thrusts of UHC. This policy reform envisions
Filipinos to be among the healthiest people in
Southeast Asia by 2022, and in Asia by 2040. It
intends to lead the country in the development of a
productive, resilient, equitable and people-centered
health system towards the attainment of UHC,
guided by the values of professionalism,
responsiveness, integrity, compassion and
excellence
WHO Cooperation for Health
The global vision of the world in 2030, spelled out
in the Sustainable Development Goals, aligns with
the Philippines’ 25-year vision AmBisyon Natin
2040. There is an ongoing process of integrating
Sustainable Development Goals (SDGs) into
AmBisyon Natin 2040 and into national, sectoral
and subnational plans and frameworks.
The World Health Organization (WHO) supports
the Government of the Philippines to foster well-
being through action by the health sector and
across sectors. WHO convenes platforms for health
involving multiple stakeholders and in addressing
the social, economic and environmental
determinants of health. WHO also takes the lead in
coordinating with other health partners to ensure
all stakeholders are aware of health issues and
activities in the country.
World Health Organization (WHO) Country Cooperation Strategic Agenda (2017–2022)
Strategic Priorities
STRATEGIC PRIORITY 1: Save lives: ensure full
access to immediate-impact interventions
STRATEGIC PRIORITY 2: Promote well-being:
empower people to lead healthy lives and enjoy
responsive health services
STRATEGIC PRIORITY 3: Protect health:
anticipate and mitigate disasters, and
environmental and emerging health threats
Main Focus Areas for WHO Cooperation
• Accelerate progress towards the targeted
elimination of TB, the AIDS epidemic,
malaria and neglected tropical diseases
• Address the high burden of viral hepatitis
• Intensify control and treatment of
dengue, Zika and chikungunya
• Strengthen the implementation of
maternal, neonatal and child health
policies across the country with a special
focus on vulnerable groups
• Expand population coverage under the
national vaccination programme
 Maximize opportunities for healthy
lifestyles
 Accelerate the introduction of tobacco-
free societies
 Increase the responsiveness of health
services to people’s needs
 Enable reproductive choices for all
women and men
 Optimize the health sector contribution to
preventing and addressing gender-based
violence and violence against children
 Support the implementation of a
comprehensive nutrition programme
• Support the implementation of the Asia
Pacific Strategy for Emerging Diseases
and Public Health Emergencies and
disaster risk management for health
• Co-lead the national Health Cluster
response in emergency situations
• Improve access to clean air, safe water
and safe food
• Advocate for “green” health-care facilities
and the reduction of carbon emissions
• Support the implementation of The
Philippine Action Plan to Combat
Antimicrobial Resistance: One Health
Approach
 STRATEGIC PRIORITY 4: Optimize the health
architecture: overcome fragmentation to achieve
universal health coverage
STRATEGIC PRIORITY 5: Use platforms for
health: support health in all settings, policies and
sectors
Sources: Global Health Observatory May 2017 http://apps.who.int/gho/data/node.cco
COMPONENTS OF THE PHILIPPINE HEALTH
CARE DELIVERY SYSTEM
Health care services are provided in the Philippines
through a dual health delivery system composed of
the public sector and the private sector.
1. Public Sector
o The public sector is largely financed
through a tax-based budgeting
system, where health services are
delivered by government facilities
under the national and local
governments.
o Include the health centers or
barangay health stations
2. Private Sectors
o The private sector, consisting of for-
profit and non-profit health-care
providers, is largely market
oriented, where health care is
• Improve the efficiency of health actors in
an evolving, federalized governance
structure
• Support the rollout of functionally
defined service delivery networks and
improved local stewardship for health
• Support efficient and effective regulatory
capacity, procurement, and management
of supplies and logistics
• Ensure protection from catastrophic
health expenditures
• Ensure equitable health workforce
distribution and capacity
• Promote evidence-informed policy-
making and planning in support of
achieving national and global target
• Work with Government departments,
legislators and organizations on health-
related taxation laws and regulations and
to promote multisectoral collaboration
• Support the educational sector and youth
organizations, through the Department of
Education and the Commission on
Higher Education
• Enable cities and islands to act as drivers
for population health
• Enhance the Philippines’ standing in
regional and global health
• Address the issue of road and traffic
injuries as a major public health concern.
• Increase health synergies between public
and private sectors
generally paid for through user fees
at the point of service.
o Include clinics. hospitals , health
insurance, manufacturing of
medicines, vaccines -medical
supplies equipment - nutrition
products - research & development -
or other any health related items
In the Philippines the components of the health
care delivery system as mandate of the Department
of Health (DOH) is to 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.
CLASSIFICATION OF HEALTH CARE
WORKERS
There are three levels of health workers in the
Philippine. These are:
1. Village or grassroots health workers
 The first contacts of the community and
initial links of health care
 They provide simple curative and
preventive health care measures promoting
healthy environment and participate in
activities geared towards the improvement
of the socio-economic level of the
community like food production program.
 These are the barangay health worker,
volunteers or traditional birth attendants or
hilot.
2. Intermediate level of health workers
o Represents the first source of professional
health care.
o They attend to health problems beyond
the competence of village workers and
provide support to front-line health
workers in terms of supervision, training,
supplies, and services.
o These are the medical practitioners,
nurses and midwives.
3. First line hospital personnel
o Provide backup health services for
cases that require hospitalization
and establish close contact with
intermediate level health workers or
village health workers.
o These are the physicians with
specialty, nurses, dentist,
pharmacists, and other health
professionals.
LEVELS OF HEALTH CARE FACILITIES
In the Philippine healthcare setting there are levels
of healthcare facilities: Level I, Level II, and Level
III.
1. Level I (Primary Level of Health Care
Facility) are the rural health units, their sub-
centers, chest clinics, malaria eradication
units, and schistosomiasis control units are
directly 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.
2. Level II (Secondary Level of Health Care
Facilities) is the smaller, non-
departmentalized hospitals including
emergency and regional hospitals. The
services offered to patients with
symptomatic stages of disease, which
require moderately specialized knowledge
and technical resources for adequate
treatment.
3. Level III (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. The services
rendered at this level are for clients afflicted
with diseases which seriously threaten their
health and which require highly technical
and specialized knowledge, facilities and
personnel to treat effectively.
TWO-WAY REFERRAL SYSTEM
Health Referral is a set of activities
undertaken by a health care provider or facility in
response to its inability to provide the necessary
intervention of patient’s need. It is done from the
community to the RHU, from the RHU to the
hospital and within the hospital internal system
and vice versa.
Health referral involves not only direct
patient care but support services such as
transportation to transfer patient from one health
facility to another. It is a two-way relationship that
requires cooperation, coordination and exchange of
information between the primary health facility
and the first referral hospital during the referral
and discharge of patient from the hospital.
Rationale of Referral System
• Most common to the most complicated and
life threatening diseases requires different
levels of health workers and health care
facility
• Maximize limited resources.
 • Avoid duplication of services.
• Promotes cooperation and complementation
of primary, secondary and tertiary health
facilities.
• Appropriate level of care made available
considering geographic factors, time, cost
and urgency
• Promotes continuity of treatment
• Sustainability
What are the major effects of deficiencies in
health referral system?
• Wastage of scarce health resources through
duplication of services and underutilization
of primary and secondary government
hospital which results to decreased
efficiency
• Increase in preventable morbidity and
mortality due to lack of appropriate
services, delayed referral and poor referral
communications which leads to decreased
effectiveness.
Framework of a two way health referral system
should:
• Include a defined packages of services
provided at different levels of care.
• Encourage an environment in which the
core referral hospital is viewed as a
community resource.
• Be responsive to local situations, while
being part of over all province-wide
referral system
• Be inclusive of the private medical sector
and NGOs involved in the provision of
community-based health care.
• Include a properly functioning
communication and transport system
(telephone, radiophone, ambulance, etc.)
When does a patient be referred to a higher levels
of care?
• When a patient needs expert advice.
• Needs a technical examination that is not
available at the health centers
• Requires a technical intervention that is
beyond the capabilities of the health center
• Requires in-patient care
Types of services available in each referral levels:
1. Barangay Health Stations
o A satellite of the RHU where the first
contact of the patient occur.
o Primary preventive and promotive
services such as:
o health education campaign
for sanitation
o Immunization.
o Normal delivery by midwife
o Contact tracing
o Liaison with the community
2. Rural Health Unit
o Primary referral center from
barangay health stations( BHS)
o Promotive and secondary level
prevention
o Treatment of primary cases not
needing inpatient services
o Outpatient services (case finding
and treatment.)
o Health education, promotive and
preventive campaigns
o Normal delivery, pre-natal and post
natal
o minor surgery
3. District Hospital
o The first level referral hospital in the health
district.
o It has a catchments of 75,000 population or
more and is about 35 kilometers to next
government facility
o It should have adequate capabilities as a
secondary level hospital or should provide
surgical, radiological and routine laboratory
services.
4. Provincial Hospitals
 The highest referral level facility in
the province.
 Provincial Hospitals cases not
treated in the district hospital are
referred to the Provincial hospital.
 It has tertiary level capabilities for
providing medical cares to cases
requiring the expertise of trained
specialists, subspecialists and other
licensed physicians using highly
specialized ancillary diagnostic and
therapeutic equipment.
Roles and responsibility of Referring Physician
o Should know what, when, whom, and where to
refer
o Accomplish referral form with all necessarily
information.
o Explain to patient rationale, reasons for choice
of doctor/hospital, preparation, expected cost,
possible outcome of referral
o Facilitate scheduling, etc. secure result of
referral
Roles and responsibilities of Consultant
Physician
o Respond promptly to a request for consultation.
report in detail all pertinent findings and
recommendation to the referring doctor and
may outline opinion to the patient.
o Communicate with patient and his family about
what they should know regarding the medical
conditions.
o Return the patient to the referring doctor’ not to
attempt by word or deed, to usurp or
undermine the primary physician role.
Republic Act 8344
An act penalizing the refusal of hospitals & medical
clinics to administer appropriate initial medical
treatment & support in emergency or serious cases,
amending for the purpose Batas Pambansa Bilang
702, otherwise known as “An act prohibiting the
demand of deposits of or advance payments in
hospitals & medical clinics in certain cases”
Implementing Rules and Regulations
Transfer of Patients:
Transfer of Patients:
 The transferring & receiving hospital
shall as much as practicable be within 10
km. radius of each other.
 The transfer of patients contemplated under
this act at all times be properly documented
 Hospitals may require a deposit or advance
payment when the patient is no longer
under the state of emergency and he or she
refuses to be transferred
 All hospital shall use a Uniform Discharge /
Transfer Slip for cases covered by RAE 8311
which shall include the following
information:
 Admission Form of transferring hospital
 Transfer Form of transferring hospital to
include but not necessarily limited to the
following:
a) Vital signs
b) Name of Attending Physician
c) Treatment given to patient
d) Name of Receiving hospital.
 Name of contact person and approving
official at receiving hospital
 Consent of the patient or companion. In
case of an unaccompanied minor patient,
they may be transferred without consent
provided that the provision of section 1 of
RA 8344 is strictly observed
 In case of refusal of transfer, the name of the
hospital, the name(s) of person who refused
and the reason (s) for the refusal
Penal Provisions for violation of RA 8344
imprisonment of not less than six months & one
day but not more than two (2) years & four months,
or at time of not less that Twenty Thousand Pesos
(P20,000.00) but not more than One Hundred
Thousand Pesos (P100,000.00) on both at the
discretion of the court.
A service delivery network (SDN) is a strategic
mechanism for expanding access to and
strengthening the continuum of care for families
across political and geographical boundaries. It
seeks to ensure the continuing provision of quality
care by combining the capacities of individual
health service delivery points into a unified
delivery system. This facilitates the collective
management of recurrent issues resulting from the
three-tiered health care system and uncoordinated
referral practices among health care system
facilities
Multi-Sectoral Approach to Health
Multisectoral approach (MSA) refers to deliberate
collaboration among various stakeholder groups
(e.g., government, civil society, and private sector)
and sectors (e.g., health, environment, and
economy) to jointly achieve a policy outcome. By
engaging multiple sectors, partners can leverage
knowledge, expertise, reach, and resources,
benefiting from their combined and varied
strengths as they work toward the shared goal of
producing better health outcomes. Improving
public health (PH) is challenging because of the
size of its population and wide variation in
geography. MSA help in addressing identified
health issues in focused way as it helps in pooling
the resources and formulating the common
objectives.
One of the major advantages is optimization of usage
of resources by avoiding duplication of inputs and
activities which tremendously improve program
effectiveness and efficiency. Willingness at the
leadership and mandate at the policy level are
necessary to plan and execute the successful
multisectoral coordination. All the major
stakeholders require to share the common vision
and perspective.
Primary health care ensures interaction between
the health sector, other sectors, and individuals and
communities to deal with the main health problems
and address the broad determinants of health. This
applies to practitioners understanding and
addressing the social circumstances of individuals
as well as their health needs, and a population
health “management” response to promote health
and prevent illness and injury. This is not possible
without partnerships with other sectors.
Multisectoral action occurs at different levels – an
example Consider the problem of drug and alcohol
abuse. As well as helping the individual, local
health services need to work with schools, local
governments (e.g. to establish alcohol-free zones),
the police and services that provide legal,
employment and relationship support. However,
local collaborations will not usually be sufficient to
tackle the problem in a comprehensive way and
prevent further issues. This will require macro-
level policy reforms, again with multiple sectors
involved to ensure appropriate policy is developed.
DEPARTMENT OF HEALTH (DOH)
The Department of Health (DOH) holds the over-
all technical authority on health as it is a national
health policy-maker and regulatory institution.
Basically, the DOH has three major roles in the
health sector: (1) leadership in health; (2) enabler
and capacity builder; and (3) administrator of
specific services. Its mandate is to develop national
plans, technical standards, and guidelines on
health. Aside from being the regulator of all health
services and products, the DOH is the provider of
special tertiary health care services and technical
assistance to health providers and stakeholders.
While pursuing its vision, the DOH adheres to the
highest values of work, which are:
 Integrity – The Department believes in
upholding truth and pursuing honesty,
accountability, and consistency in
performing its functions.
 Excellence – The DOH continuously
strive for the best by fostering innovation,
effectiveness and efficiency, pro-action,
dynamism, and openness to change.
 Compassion and respect for human
dignity – Whilst DOH upholds the quality
of life, respect for human dignity is
encouraged by working with sympathy
and benevolence for the people in need.
 Commitment – With all our hearts and
minds, the Department commits to
achieve its vision for the health and
development of future generations.
 Professionalism – The DOH performs its
functions in accordance with the highest
ethical standards, principles of
accountability, and full responsibility.
 Teamwork – The DOH employees work
together with a result-oriented mindset.
 Stewardship of the health of the people –
Being stewards of health for the people,
the Department shall pursue sustainable
development and care for the
environment since it impinges on the
health of the Filipinos.
Together with its attached agencies, the DOH –
constituted of various central bureaus and services
in the Central Office, Centers for Health
Development (CHD) in every region, and DOH-
retained hospitals – performs its roles to
continuously improve the country’s health care
system.
DOH VISION
Filipinos are among the healthiest people in Southeast
Asia by 2022, and Asia by 2040
DOH MISSION
To lead the country in the development of a productive,
resilient, equitable and people-centered health system
HISTORY OF DOH
Pre-Spanish and Spanish periods (before 1898)
• traditional health care (herbs &
rituals)
• dispensary of indigent patients of
Manila
• Medicus Titulares (provincial health
workers)
• Superior Board of Health & Charity,
1888
June 23, 1898
• creation of E. Aguinaldo government of
Department of Public Works, Education &
Hygiene
September 29, 1898
 • gen. order no. 15
• established the Board of Health for the City
of Manila
July 1, 1901
• Act no. 157: Board of Health of Philippine
Islands
• Acts no, 307 & 308: provincial and
municipal boards
October 26, 1905
• Act no. 1407
• establishment of Bureau of Health
1912
• Act no. 2156 (Fajardo Act):health fund for
travel and salaries
1915
• Act no. 2568: from BOH to Philippine
Health Service “ semi-military system of
public health administration”
August 2, 1916
• Act 2711 w/c included the Public Health
Law of 1917
1932
• Act no. 4007: Reorganization Act of 1932
May 31, 1939
• Commonwealth act no. 430 created the
Department of Public Health & Welfare, but
was only completed through E.O. no. 317,
Jan. 7, 1941
• Dr. Jose Fabella became its first secretary
October 4, 1947
• E.O. no. 94: post war reorganization of the
Department of Health & Public Welfare
• resulted in the split of Department of Public
Welfare (w/c became Social Welfare
Administration) and Philippine General
Hospital to the Office of the President
• another split between curative (Bureau of
Hospitals ) & preventive services (Bureau of
Health) –
• Nursing Service Division was also
established
January 1, 1951
• conversion of Sanitary District to Rural
Health Unit, carrying the ff. services:
o maternal & child health
o environmental health
o communicable disease control
o vital statistics
o medical care
o health education
o public health nursing
• resulted in passage of Rural Health Act of
1954 (RA 1082)
1970
• conceptualization of the Restructured
Health Care Delivery System (primary,
secondary & tertiary levels of care)
June 2, 1978
• P.D. 1937 renamed DOH to Ministry of
Health during the Martial Law
• Sec. Gatmaitan was the 1st minister of
health
December 2. 1982
• E.O. 851 reorganized Ministry of Health as
an integrated health care delivery system
through the creation of Integrated
Provincial Health Office, combining the
public health and hospital operations under
the PHOs
April 13, 1987
• E.O. no. 119: MOH was back in the name
Department of Health by President Cory
Aquino
October 10, 1991
• RA 7160 known as the Local Government
Code: all structures, personnel & budgetary
allocations from the provincial health level
down to the barangay were devolved to the
LGU to facilitate health service delivery
• From PROVINCIAL TO LOCAL
GOVERNMENT (devolution/ devolved
health sector)
May 24, 1999 - E.O. 102 “Redirecting the Functions
& Operations of the DOH” by Pres. Joseph Estrada
1999-2004
• Development of the Health Sector Reform
Agenda (HSRA)
2005 to present
• development of a plan to rationalize the
bureaucracy in an attempt to scale down
including the DOH
ROLES AND FUNCTIONS OF FUNCTION OF
DOH
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. The DOH
has three major roles in the health sector:
1. Leadership in Health
o national policy & regulatory
institution
o leadership in formulation,
monitoring, & evaluation of health
policies, plans & programs
o serve as advocate in health policies,
plans & programs
2. Enabler & Capacity Builder
o innovate new strategies in health
o monitoring & evaluation of national
health policies, plans & programs
o ensure highest achievable standards
of quality HC, health promotion &
health protection
3. Administrator of Specific Services
o manage selected national & sub-
national health facilities & hospitals
w/ modern facilities that shall serve
as referral centers
o administer direct services for
emerging health concerns
o emergency response services in
disaster and epidemics
MILLENNIUM DEVELOPMENT GOALS
(MDGS)
The United Nations Millennium Development
Goals are eight goals that all 191 UN member states
have agreed to try to achieve by the year 2015. The
United Nations Millennium Declaration, signed in
September 2000 commits world leaders to combat
poverty, hunger, disease, illiteracy, environmental
degradation, and discrimination against women.
The MDGs are derived from this Declaration, and
all have specific targets and indicators. The Eight
Millennium Development Goals are:
1. To eradicate extreme poverty and hunger;
2. To achieve universal primary education;
3. To promote gender equality and empower
women;
4. To reduce child mortality;
5. To improve maternal health;
6. To combat HIV/AIDS, malaria, and other
diseases;
7. To ensure environmental sustainability; and
8. To develop a global partnership for
development.
The MDGs are inter-dependent; all the MDG
influence health, and health influences all the
MDGs. For example, better health enables children
to learn and adults to earn. Gender equality is
essential to the achievement of better health.
Reducing poverty, hunger and environmental
degradation positively influences, but also depends
on, better health. MDG’s 4, 5 and 6 are health
related goals.
The Millennium Development Goals in the
Philippines
Arising from the historic adoption of the
Millennium Declaration by 189 countries in 2000,
the Millennium Development Goals (MDGs) give
voice to the global aspiration to eradicate extreme
poverty. The MDGs are eight concrete and
interconnected goals, with a corresponding set of
measurable targets and indicators. This
development framework represents a remarkable
global partnership between poor countries that
pledge to govern better and invest in human
development and rich countries that promise to
support them.
In the Philippines, the MDGs have been tightly
integrated into national development plans by the
Government, and utilized to monitor their
implementation. The MDGs have also been broadly
adopted by all relevant development organizations,
from local government units (LGUs) to civil society
organizations (CSOs.) They serve as a common
foundation for development, resulting in better
alignment of interventions and coordination,
allocation, and use of resources.
Yet, despite strong institutional support, overall
progress on the MDGs is not encouraging.
Interventions for poverty, education, maternal
health, HIV/AIDS, and the environment need to be
accelerated, while addressing the glaring
disparities in rates of progress across regions. It is
clear that if success is to be achieved, efforts need to
be redoubled; current initiatives in all areas must
be scaled-up, greater resources must be mobilized
while more efficiently utilizing existing resources,
and stronger advocacy and capacity must be
developed, especially at the local level.
 SUSTAINABLE DEVELOPMENT GOALS
(SDGS)
The Sustainable Development Goals (SDGs), also
known as the Global Goals, were adopted by all
United Nations Member States in 2015 as a
universal call to action to end poverty, protect the
planet and ensure that all people enjoy peace and
prosperity by 2030.
The United Nations Sustainable Development
Goals (UN SDGs, also known as the Global Goals)
are 17 goals with 169 targets that all UN Member
States have agreed to work towards achieving by
the year 2030.They set out a vision for a world free
from poverty, hunger and disease.
The 17 SDGs are integrated—that is, they
recognize that action in one area will affect
outcomes in others, and that development must
balance social, economic and environmental
sustainability.
Through the pledge to Leave No One Behind,
countries have committed to fast-track progress
for those furthest behind first. That is why the
SDGs are designed to bring the world to several
life-changing ‘zeros’, including zero poverty,
hunger, AIDS and discrimination against women
and girls.
The Sustainable Development Goals are a call for
action by all countries – poor, rich and middle-
income – to promote prosperity while protecting
the planet. They recognize that ending poverty
must go hand-in-hand with strategies that build
economic growth and address a range of social
needs including education, health, social
protection, and job opportunities, while tackling
climate change and environmental protection
Health has a central place in SDG 3 “Ensure healthy
lives and promote well-being for all at all ages”,
underpinned by 13 targets that cover a wide
spectrum of WHO’s work. Almost all of the other
16 goals are related to health or their achievement
will contribute to health indirectly.
The SDGs aim to be relevant to all countries – poor,
rich and middle-income – to promote prosperity
while protecting the environment and tackling
climate change. They have a strong focus on
improving equity to meet the needs of women,
children and disadvantaged populations in
particular so that “no one is left behind”.
This agenda builds on the Millennium
Development Goals (MDGs) which were 8 goals
that UN Member States signed in September 2000
to achieve targets to combat poverty, hunger,
disease, illiteracy, environmental degradation and
discrimination against women by 2015.
Everyone is needed to reach these ambitious
targets. The creativity, knowhow, technology and
financial resources from all of society is necessary
to achieve the SDGs in every context.
The 17 Sustainable Development Goals are the
following:
1. End poverty in all its forms everywhere
2. End hunger, achieve food security and
improved nutrition and promote
sustainable agriculture
3. Ensure healthy lives and promote well-
being for all at all ages
4. Ensure inclusive and equitable quality
education and promote lifelong learning
opportunities for all
5. Achieve gender equality and empower all
women and girls
6. Ensure availability and sustainable
management of water and sanitation for all
7. Ensure access to affordable, reliable,
sustainable and modern energy for all
8. Promote sustained, inclusive and
sustainable economic growth, full and
productive employment and decent work
for all
 9. Build resilient infrastructure, promote
inclusive and sustainable industrialization
and foster innovation
10. Reduce inequality within and among
countries
11. Make cities and human settlements
inclusive, safe, resilient and sustainable
12. Ensure sustainable consumption and
production patterns
13. Take urgent action to combat climate
change and its impacts
14. Conserve and sustainably use the oceans,
seas and marine resources for sustainable
development
15. Protect, restore and promote sustainable use
of terrestrial ecosystems, sustainably
manage forests, combat desertification, and
halt and reverse land degradation and halt
biodiversity loss
16. Promote peaceful and inclusive societies for
sustainable development, provide access to
justice for all and build effective,
accountable and inclusive institutions at all
levels
17. Strengthen the means of implementation
and revitalize the global partnership for
sustainable development
SDG 3: Ensure healthy lives and promote
well-being for all at all ages
The Millennium Development Goals (MDGs) have
made a significant contribution to improving global
health, e.g. in the fight against diseases such as
AIDS, tuberculosis and malaria. For example, the
number of malaria deaths has fallen by 60% since
2000. However, results have failed to meet
expectations in many areas, such as reducing child
and maternal mortality.
The experience of the MDGs has shown that health
problems need to be viewed in context, not in
isolation. Education and food security influence the
effectiveness of healthcare programmes. Goal 3
continues along the same lines as the MDGs, for
example with regard to child and maternal
mortality as well as communicable diseases such as
AIDS, malaria and tuberculosis, while also
including provisions on combating non-
communicable diseases such as diabetes and
preventing traffic accidents and narcotics abuse.
All people should have access to good-quality
healthcare and medicines, including financial risk
protection. Another objective for 2030 is to ensure
universal access to sexual and reproductive
healthcare, including family planning, information
and education.
The targets for SDG 3 are outlined below:
1. By 2030, reduce the global maternal
mortality ratio to less than 70 per 100 000
live births.
2. By 2030, end preventable deaths of
newborns and children under 5 years of
age, with all countries aiming to reduce
neonatal mortality to at least as low as 12
per 1,000 live births and under-5 mortality
to at least as low as 25 per 1000 live births.
3. By 2030, end the epidemics of AIDS,
tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne
diseases and other communicable diseases.
4. By 2030, reduce by one third premature
mortality from non-communicable diseases
through prevention and treatment and
promote mental health and well-being.
5. Strengthen the prevention and treatment of
substance abuse, including narcotic drug
abuse and harmful use of alcohol.
6. By 2020, halve the number of global deaths
and injuries from road traffic accidents.
7. By 2030, ensure universal access to sexual
and reproductive health-care services,
including for family planning, information
and education, and the integration of
reproductive health into national strategies
and programmes.
8. Achieve universal health coverage,
including financial risk protection, access to
quality essential health-care services and
access to safe, effective, quality and
affordable essential medicines and vaccines
for all.
9. By 2030, substantially reduce the number of
deaths and illnesses from hazardous
chemicals and air, water and soil pollution
and contamination.
 10. Strengthen the implementation of the WHO
Framework Convention on Tobacco Control
in all countries, as appropriate.
11. Support the research and development of
vaccines and medicines for the
communicable and non-communicable
diseases that primarily affect developing
countries, provide access to affordable
essential medicines and vaccines, in
accordance with the Doha Declaration on
the TRIPS Agreement and Public Health,
which affirms the right of developing
countries to use to the full the provisions in
the Agreement on Trade Related Aspects of
Intellectual Property Rights regarding
flexibilities to protect public health, and, in
particular, provide access to medicines for
all.
12. Substantially increase health financing and
the recruitment, development, training and
retention of the health workforce in
developing countries, especially in least
developed countries and small island
developing states.
13. Strengthen the capacity of all countries, in
particular developing countries, for early
warning, risk reduction and management of
national and global health risks.
The Sustainable Development Goals in the
Philippines
In September 2015, the Philippines, together with
192 other United Nations (UN) member states,
committed to achieving the 17 Sustainable
Development Goals (SDGs) and their 169 targets by
2030. The SDGs, also called the Global Goals, have
a range of economic, social, environmental, and
governance targets and there was recognition, early
on, that these need to be achieved in order to attain
the long-term vision as articulated in AmBisyon
Natin 2040. The SDGs present a bold commitment
to finish what has been started through the
Millennium Development Goals (MDGs) in 2015.
The Philippines affirms its commitment to achieve
the SDGs by 2030, if not sooner, especially as the
Global Goals are in sync with the country’s
development plans and long-term aspirations for
2040.
In the Millenium Development Goals (MDGs),
eight anti-poverty targets had been set to be
achieved by 2015 and the Philippines only made
some progress. Poverty has not been ended. The
development agenda called “Sustainable
Development Goals” builds on the MDGs. The
proposed framework has 17 goals with 169 targets
Since the adoption of the SDGs, the Philippine
government has been setting up the policy and
enabling environment for their implementation, as
well as compiling and analyzing data for
monitoring the country’s conditions on the SDGs.
The National Economic and Development Authority
(NEDA), as the cabinet-level agency responsible for
development and planning in the country, looks into
synergies of the SDGs indicator framework in
relation to the monitoring of the country’s medium-
and long-term development plans. All concerned
government agencies have been enjoined to
provide the necessary data support for monitoring
the Global Goals with the Philippine Statistics
Authority (PSA), an attached agency of NEDA,
designated as the official repository of SDG
indicators
What is the AmBisyon Natin 2040?
AmBisyon Natin 2040 is a picture of the future, a
set of life goals and goals for the country. It is
different from a plan, which defines the strategies
to achieve the goals. It is like a destination that
answers the question “Where do we want to be?”A
plan describes the way to get to the
destination; AmBisyon Natin 2040 2040 is the
vision that guides the future and is the anchor of
the country’s plans.
AmBisyon Natin 2040 and the Philippine
Development Plan (PDP) AmBisyon Natin 2040
represents the collective long-term vision and
aspirations of the Filipino people for themselves
and for the country. It describes the kind of life that
people want to live, and how they want the country
to be by 2040. “By 2040, the Philippines will have
been a prosperous, predominantly middle-class
society where no one is poor, our people live long
and healthy lives, are smart and innovative, and
live in a high trust society.”

This long-term vision is a basis for national unity

and is meant to guide development planning across
at least four government administrations. The
attainment of the SDGs, set at 2030, should pave the
way for the achievement of AmBisyon Natin 2040. The
vision, which necessitates inter-generational equity,
is consistent with the core principles of the SDGs of
sustainable development and leaving no one
behind. Sustainable development requires long-
term planning where present development should
never be at the expense of future generations. This
is a requisite for the Filipino AmBisyon of a life that
is matatag (strongly rooted), maginhawa
(comfortable), and panatag (secure).