TANCHULING COLLEGE, INC.

College of Nursing
Imperial Court Subdivision, Phase II,
Legazpi City 4500 Philippines
Tel. # (052) 480-6106/(052) 742-0098
http://www.tanchuling.edu.ph

The Health Care

Delivery System
Group 2

Leader:
Glyza R. Ebrada
Members:
Maria Luisa Nuñez
Lyra Shane Bueno
Cristymae Triñanes
Clareza Monteveroz
Kenn Borbe
A Brief Introduction to the Health Care Delivery System
Health care delivery system often involves issues of cost and challenges nations go through a
struggle to overcome multiple forces in efforts to advance the nation's health within the context of their
financial and political situations.

The following factors in shaping 21st-century health further influence the healthcare delivery system:

➢ Healthcare reforms
➢ Demographics
➢ Globalization
➢ Poverty and growing disparities
➢ Social disintegration

The Philippine healthcare system is shared between the public and private sectors. The pandemic
allowed hospitals to upgrade and increase their facilities to cope with the situation.

Health Sectors

➢ Government Sectors
➢ Non-Government Sectors
➢ Private Sectors

A. WORLD HEALTH ORGANIZATION

When diplomats formed the United Nations (UN) in 1945, they also discussed the creation of a
global health organization. The World Health Organization (WHO) was the outcome of these discussions.
The WHO constitution came into force on April 7, 1948. Since then, April 7 has been celebrated each
year as World Health Day (WHO, 2013a). With its headquarters in Geneva, Switzerland, WHO has 150
country offices and six world regional offices for Africa, the Americas, the Eastern Mediterranean,
Europe, Southeast Asia, and the Western Pacific (WHO, 2019a). The Philippines is a member of the
Western Pacific Region, which holds office in Manila).

The WHO constitution states that its objective is the attainment by all people of the highest
possible level of health (WHO, 2006).

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. Each MDG has targets set for 2015 and indicators
to monitor progress from 1990 levels. Several of these relate directly to health.

➔ Millenium Development Goals (SDGs) - The United Nations Millennium Development Goals
(MDGs) are 8 goals that UN Member States have agreed to try to achieve by the year 2015.
 Health-related MDGs:

➢ Millennium Development Goal 1: eradicate extreme poverty and hunger

➢ Millennium Development Goal 4: reduce child mortality
➢ Millennium Development Goal 5: improve maternal health
➢ Millennium Development Goal 6: combat HIV/AIDS, malaria and other diseases
➢ Millennium Development Goal 7: ensure environmental sustainability
➢ Millennium Development Goal 8: develop a global partnership for development

➔ Sustainable Development Goals (SDGs) - In 2015, all the countries in the United Nations
adopted the 2030 Agenda for Sustainable Development. It sets out 17 Goals.

Health-related SDGs:

➢ Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at
all ages. - The targets of SDG are 3 to ensure healthy lives and promote well-being for all
at all ages.

B. PHILIPPINE DEPARTMENT OF HEALTH

(DOH; Filipino: Kagawaran ng Kalusugan)

The Department of Health (DOH) is the national agency mandated to lead the health sector
towards assuring quality health care for all Filipinos.

1. MISSION: Lead the country in the development of a productive, resilient, equitable, and
people-centered health system" (DOH, 2019).
VISION: Filipinos among the healthiest in Southeast Asia by 2022 and in Asia by 2040.

In the pursuit of its vision and execution of its mission, the DOH has the following major roles:
(1) leader in health, (2) enabler and capacity builder, and (3) administrator of specific services (DOH,
2013a). Moreover, based on the mandate of the Philippine Constitution the DOH organizes various health
events all year round to instill health consciousness among Filipinos (see picture to be attached in PPT)

2. HISTORICAL BACKGROUND

23 June 1898 – Creation of the Department of Public Works, Education &

Hygiene.
29 September 1898 – Establishment of the Board of Health for the City of
Manila.
 1899 – 1905 – Abolition of the Board of Health
1906 – Passage of Act No. 1487 of the Philippine Commission repealing Act
No. 307 wherein the provincial Board of Health gave way to the Office of the
District Health Officer.
1912 – "Fajardo Act" is now known as the "Health Fund".
1915 – Changing the name of the Bureau of Health to the Philippine Health
Service, which was later changed to its former name.
1932 –"The Reorganization Act of 1932",
01 January 1941 – Creation of the DOH and Public Welfare
1947- Reorganization of government offices
1950 – The DOH gained additional functions brought about by the transfer of
the Institute of Nutrition.
1958 – The creation of 8 regional health offices and 2 Undersecretaries of
Health.
1971 – The creation of the Food and Drug Administration
1972 – Through Letter of Implementation
Sept. 24, 1972 – The DOH was renamed Ministry of Health.
1982 - Under Executive Order No. 851, the Health Education and Manpower
Development Service was created
1986 – The Ministry of Health became the Department of Health again.
1987 – Another re-organization under Executive Order No. 119
1992 – Full implementation of Republic Act No. 7160 or Local Government
Code.
1999 – The functions and operations of the DOH were directed to become
consistent
2000 – The year 2000 marked the institutionalization of the Health Sector
Reform Agenda (HSRA).
2001 –Administrative Order 37 which contained the guidelines on the
operationalization of the HSRA implementation.
2003 – The One-Script Systems Improvement Program.
2005 – FOURmula ONE for Health (F1) was launched
2006 – The Presidential Anti-Graft Commission recognized and awarded the
DOH is the number one government agency in fighting corruption.

3. LOCAL HEALTH SYSTEM AND DEVOLUTION OF HEALTH SERVICES

In The Philippines, the health system is a complex, multi-layered system in which responsibilities
in the healthcare sector are fragmented. Responsibility is shared between the central government and
Local Government Units that have full autonomy to organize and finance their ‘own’ regional systems.

The Local Government Code (RA 7160) was enacted to bring about genuine and meaningful
local autonomy. This will enable local governments to attain their fullest development as self-reliant
communities and make them more effective partners in the attainment of national goals. It mandates the
devolution of basic services from the national government to LGUs (see attached image for the structure
of national and local health systems).

Devolution refers to the act by which the national government confers power and authority upon the
various LGUS to perform specific functions and responsibilities (Congress of the Republic of the
Philippines, 1991).

Source: Structure of Philippine Public Health Care System Showing National and Local Health System. Source: Dayrit MM, Lagrada LP, Picazo
OF, Pons MC, Villaverde MC. The Philippines Health System Review. Vol. 8 No. 2. New Delhi: World Health Organization, Regional Office for
South-East Asia; 2018.

4. CLASSIFICATION OF HEALTHCARE FACILITIES (DOH AO-0012A)

Advances in health sciences and services have brought about the development of different types
of health facilities. In response, the DOH issued Administrative Order 2012-0012 (Rules and Regulations
Governing the New Classification of Hospitals and Other Health Facilities in the Philippines) that
provides for a new classification scheme of health facilities (see Table below).
 ➢ Primary care facility - a first-contact health care facility that offers basic services including
emergency services and provision for normal deliveries.
Example: infirmaries and birthing (lying-in) facilities.
➢ Custodial care facility - health facility that provides long-term care, including basic services
like food and shelter, to patients with chronic conditions requiring ongoing health and nursing
care due to impairment and a reduced degree of independence in activities of daily living, and
patients in need of rehabilitation.
Examples: custodial psychiatric facilities, substance/drug abuse treatment and rehabilitation
centers, sanitaria/ leprosaria, and nursing homes. to homes.
➢ Diagnostic/therapeutic facility - a facility for the examination of the human body, specimens
from the human body for the diagnosis, sometimes treatment of disease, or water for drinking
water analysis.
This category is further classified into:
1. Laboratory facilities, such as, but not limited to the following:
a. Clinical laboratory and
b. HIV testing laboratory
c. Blood service facility
d. Drug testing laboratory
e. Newborn screening laboratory
f. Laboratory for drinking water analysis
2. Radiologic facility providing services such as X-ray, CT scan, mammography,
MRI, and ultrasonography.
3. 3. Nuclear medicine facility - facility regulated by the Philippine Nuclear
Research Institute utilizing applications of radioactive materials in diagnosis,
treatment, or medical research, with the exception of the use of sealed radiation
sources in radiotherapy as in internal radiation therapy.

➢ Specialized outpatient facility - a facility that performs highly specialized procedures on an

outpatient basis.
Examples: dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic center/clinic,
cancer radiation facility, and physical medicine and rehabilitation center/clinic.

5. PHILIPPINE HEALTH AGEND 2010-2022

The Philippine Health Agenda of “All for Health, Towards Health for All” has the following goals:

➢ financial risk protection - protecting all families especially the poor, marginalized, and
vulnerable against the high cost of health care,
➢ better health outcomes - ensuring the best health outcomes for all, without socio-economic,
ethnic, gender, and geographic disparities, and
➢ responsiveness of the health system - promoting health and delivering health care through
means that respect, value, and empower clients and patients as they interact with the health
system.
The ACHIEVE Strategy:

➔ Advanced quality, health promotion, and primary care

➔ Cover all Filipinos against health-related financial risk
➔ Harness the power of strategic Human Resources for Health Development
➔ Invest in eHealth and data for decision-making
➔ Enforce standards, accountability, and transparency
➔ Value all clients and patients, especially the poor, marginalized, and vulnerable
➔ Elicit multi-sectoral and multi-stakeholder support for health

C. PRIMARY HEALTH CARE (PHC)

1. Brief History
➢ Primary Health Care (PHC) was declared during the First International Conference on
Primary Health Care held in Alma Ata, Russia on September 6-12, 1978 by the World
Health Organization (WHO). The goal was "Health for All by the Year 2000". This was
adopted in the Philippines through Letter of Instruction 949 signed by President Marcos
on October 19, 1979, and has an underlying theme of "Health in the Hands of the People
by 2020."
2. Legal Basis
➢ Letter of Instruction (LOI) 949 signed on October 19, 1979, by then President Ferdinand
E. Marcos - one year after the First International Conference on Primary Health Care was
held in Alma Ata, USSR on September 6 - 12, 1978, sponsored by the World Health
Organization and UNICEF

3. Definitions
➢ Primary health care is "essential health care based on practical, scientifically sound, and
socially acceptable methods and technology made universally accessible to individuals
and families in the community through their full participation and at a cost that the
community can afford to maintain at every stage of their development in the spirit of
self-reliance and self-determination" (WHO/UNICEF 1978, in Stanhope and Lancaster,
1992:172).
4. Goals
➢ HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF
THE PEOPLE by the year 2020.
➢ An improved state of health and quality of life for all people is attained through SELF
RELIANCE.
5. Elements

A. Environmental Sanitation (adequate supply of safe water and good waste disposal)
B. Control of Communicable Disease
C. Immunization
 D. Health Education
E. Maternal and Child Health and Family Planning
F. Adequate Food and Proper Nutrition
G. Provision of Medical Care and Emergency Treatment
H. Treatment of Locally Endemic Disease
I. Provision of Essential Drugs

6. Principles And Strategies

Principles:
The key principles that set PHC apart from the traditional mode of healthcare delivery are:

➔ Accessibility, affordability, acceptability, and availability

➔ Support mechanisms
➔ Multisectoral approach
➔ Community participation
➔ Equitable distribution of health resources
➔ Appropriate technology

Strategies:

a. Reorientation and reorganization of the national healthcare system with the establishment of a
functional support mechanism in support of the mandate of devolution under the Local
Government Code of 1991.
b. Effective preparation and enabling process for health action at all levels.
c. Mobilization of the people to know their communities and identifying their basic health needs
with the end view of providing appropriate solutions (including legal measures) leading to
self-reliance and self-determination.
d. Development and utilization of appropriate technology focusing on local indigenous resources
available in and acceptable by the community.
e. Organization of communities arising from their expressed needs which they have decided to
address and this is continually evolving in pursuit of their own development.
f. Increase opportunities for community participation in local-level planning, management,
monitoring, and evaluation within the context of regional and national objectives.
g. Development of intra-sectoral linkages with other governments and private agencies so that
programs of the health sector are closely linked with those of other socio-economic sectors at
national, intermediate, and community levels.
h. Emphasizing partnership so that the health workers and the community leaders/members view
each other as partners rather than merely providers and receivers of healthcare respectively.

D. Levels of Prevention
 The Levels of Prevention

PRIMARY SECONDARY TERTIARY

Prevention Prevention Prevention

Definition An intervention An intervention An intervention

implemented before implemented after a implemented after a
there is evidence of a disease has begun, but disease or injury is
disease or injury before it is established
symptomatic.

Intent Reduce or eliminate Early identification Prevent sequelae (stop

causative risk factors (through screening) and bad things from getting
(risk reduction) treatment worse)

Example Prevent addiction from Screen pregnant women Treat addicted women
occurring for substance use
during prenatal visits Treat babies with NAS
Prevent pregnancy and refer them for
treatment

E. UNIVERSAL HEALTH CARE

➢ LEGAL BASIS

➔ Republic Act of 11223, an Act instituting Universal Health Care for all Filipino,
prescribing reforms in the health care system, and appropriating funds therefor. Approved
by Gloria Macapagal-Arroyo (Speaker of the House Representatives), Vicente C. Sotto
III (President of the Senate), Dante Roberto P. Maling (Acting Secretary General House
of Representatives), Myra Marie D. Villarica (Secretary of the Senate). This act which is
a consolidation of Senate Bill No. 1896 and House Bill No. 5874 was passed by the
Senate and the House of Representatives on December 10, 2018.

APPROVED: February 20, 2019, RODRIGO ROA DUTERTE (President of the Philippines).

➢ BACKGROUND and RATIONALE

Background:

➔ 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.

Rationale:

➔ Financial risk protection through expansion in enrollment and benefit delivery of the National
Health Insurance Program (NHIP)
➔ Improved access to quality hospitals and health care facilities; and
➔ Attainment of health-related Millennium Development Goals (MDGs).

F. ESTABLISHING GOALS AND OBJECTIVES:

Goal of Primary Health Care:

● HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE
PEOPLE by the year 2020.
● An improved state of health and quality of life for all people is attained through SELF
RELIANCE.

Key Strategy to Achieve the Goal:

Partnership with and Empowerment of the People – permeate as the core strategy in the effective
provision of essential health services that are community-based, accessible, acceptable, and sustainable, at
a cost, that the community and the government can afford.

Objectives of Primary Health Care

➔ Improvement in the level of health care of the community

➔ Favorable population growth structure
➔ Reduction in the prevalence of preventable, communicable, and other diseases.
➔ Reduction in morbidity and mortality rates especially among infants and children.
➔ Extension of essential health services with priority given to the underserved sectors.
➔ Improvement in Basic Sanitation
➔ Development of the capability of the community aimed at self-reliance.
➔ Maximizing the contribution of the other sectors for the social and economic development of the
community.

G. SELECTING APPROPRIATE FAMILY NURSING INTERVENTIONS

Family nursing interventions are those that address not only the patient but other family members
as well. They could entail education of family members about caring for the patient; or, in the case of new
mothers, interventions could consist of instruction and assistance with breastfeeding and other forms of
infant care.
Nursing Interventions Include

➔ Bedside Care and Assistance - Bedside care is more than just passing medications and taking
vitals. It's the process where the nurse provides emotional support and advocates for the patient.

➔ Administration of Medication - Ensuring that medications are given safely and accurately is a
cornerstone of safe medical care.

➔ Postpartum support - Families suffering from postpartum depression, anxiety, and distress.

➔ Feeding assistance - able to maintain/improve nutrient intake, overall health, and well-being will
benefit. Monitoring of vitals and recovery progress - allows medical professionals to assess

H. CATEGORIES OF INTERVENTION

➔ Promotive - services aim to create living conditions that are conducive to good

➔ Curative - involves treatment intended to alleviate the symptoms or cure a current medical
condition.

➔ Preventive -focuses on preventing disease and illness and promoting overall general health and
well-being.

➔ Rehabilitative - the act of restoring someone to health or normal life through training & therapy
after addiction or illness.

REFERENCES:

● MARY A. NIES, MELANIE McEWEN. COMMUNITY AND PUBLIC HEALTH NURSING

2ND PHILIPPINE EDITION
● Jean P. Reyala, Zenaida P. Nisce, Florida R. Martinez, Nelia F. Hizon. Carolina A. Ruzol, Remy
B. Dequiña, Azucena P. Alcantara, Ma. Thelma C. Bermudez, Gilda R. Estipona (2000).
Community Health Nursing Services in the Philippines 9th Edition
● REYALA, J., NISCE, Z., MARTINEZ, F., HIZON, N., RUZOL, C., DEQUIÑA, R.,
ALCANTARA, A., BERMUNDEZ, M.T., ESPITONA, G. COMMUNITY HEALTH NURSING
SERVICES IN THE DEPARMENT OF PHILIPPINES. 9TH EDITION. COMMUNITY
HEALTH NURSING SECTION, NATIONAL LEAGUE OF THE PHILIPPINE
GOVERNMENT NURSES, INC. 2000.
● THE WORLD HEALTH ORGANIZATION
● NIES, M., MCEWEN, M. COMMUNITY AND PUBLIC HEALTH NURSING. 2ND
PHILIPPINE EDTION
● Nursing Care of the Community (A comprehensive text on community and public health nursing
in the Philippines) Zenaida U. Famorca, Mary A. Nies, Melanie McEwen
● https://www.health-science-degree.com/faq/what-is-a-nurses-role-in-curative-preventive-rehabilit
ative-and-palliative-care/
● https://www.indeed.com/career-advice/career-development/nursinginterventions#:~:text=Family
%20nursing&text=An%20example%20of%20a%20family,feed%20and%20swaddle%20their%20
baby.