CHAPTER II

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

HEALTH CARE SYSTEM

Is the totality of service offered by all health disciplines. The major purpose of delivery system was to provide care to ill and injured.

MAJOR PLAYERS:
PUBLIC SECTOR
Which is largely finance through a tax based budgeting system at both national and local levels. And were Health care is generally given free at the point of service.

Consist:
National and Local government agencies providing health services. It also contains provincial health teams made up of DOH representatives to the local health boards and personnel.

.PRIVATE SECTOR Largely market oriented and where Health care is paid through user fees at the point of service.

Consists: For profit and non-profit health providers. health insurance. medical supplies. It includes providing health services in clinics and hospitals. manufacture of medicine. human resource development and other health related services. equipment and other health and nutrition products. . research and development. vaccine.

Historical Background of DOH .

the DPWEH was created by virtue of a decree signed by president Emilio Aguinaldo.Pre-spanish and spanish periods Traditional health care practices specially the used of herbs and rituals for healing were widely practiced during this period.1898. JUNE 23. .15 established the board of health for city of Manila. SEPTEMBER 29. Orders No.1898.With the primary objective of protecting the health of American soldiers Gen.

OCT. consolidated the municipalities into sanitary division and established as the Health Fund for travel and salaries .Board of health for the Philippine Islands was crated through Act No.26. 1407 1912.1905.JUNE 1.This functioned as the local health board of Manila. 2156 known as Fajardo Act. 157.1901.The insular board of health proved to be inefficient operationally so it was abolished and was replaced by the Bureau of health under the Department of Interior through Act No.Act No.

2. reverted back the Philippine service into Bureau of Health. filipino struggle for Philippine Independence from the American rule. and combined the Bureau of public welfare. AUG.Act No. 1932. . Of 1932.The passage of the Jones Law also known as the Philippine Autonomy Act.Act No.1916.1915. 4007 known as the Reorganization Act.2468 transformed the Bureau of health into a commissioned service called The Philippine Health Service.

PHILIPPINE COMMONWEALTH AND JAPANESE OCCUPATION MAY31.317 1942.1939. various reorganization and issuances for health and welfare were instituted and lasted until Americans came. 94 provided for the post-war reorganization of the DOH and public welfare .Commonwealth Act No.During Japanese occupation.1947.Exe. Order No.430 created the Department Health and Welfare but the full implementation was only completed through the Exe. OCT4. Order No.

1. carrying out 7 basic health services: Mother and Child Services Environmental Health Communicable disease control Vital Statistics Medical Care Health Education Public Health Nursing .JAN.1951.The office of the president of the sanitary district was converted into RHU.

Order No. secondary and tertiary level of care. 228 Provided for what is prescribed as the “most sweeping” reorganization in the history of DOH.The RHCDS was conceptualized. Classified Health services into primary. Pres. DEC.20.1958.1978-With the proclamation of Martial Law.1982. . 851 signed by president Ferdinand Marcos reorganized the ministry of health as an integrated HCDS. JUNE 2.Exe. 1970.Exe.2. Order No. Decree 1397 renamed the DOH to MOH.FEB.

OCT.R. 102 “redirecting the functions and operations of the DOH” by president Estrada granted the DOH to proceed with its rationalization and streamlining plan. 1991. 119 “Reorganizing the ministry of health” by president Aquino saw in major change in the structure of the ministry. 1999.APR.Exe. MAY24. Order No. Transformed the MOH back to DOH. This brought about major shift in the role and functions of DOH.10. .13.1987. Order No.Exe.A. 7160 known as the LGC provided for the decentralization of the entire government.

2005 ongoing. regulated and finance.Development of HSRA which described the major strategies. organizational and policy changes and public investment needed to improve the way health care is delivered.Development of a plan to rationalize the bureaucracy in an attempt to scale down including the DOH. .1999-2004.

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National authority on health providing technical and other resource assistance .

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Three Specific Roles In the Health Sector Leadership in Health Enabler and Capacity Builder Administrator of Specific Services .

Leadership in Health Serve as the national policy and regulatory institution. Provide leadership in the formulation Serve as advocate in the adoption .

initiate public discussion.Enabler and Capacity Builder Innovate new strategies in health. disseminate policy research outputs. . Exercise oversight functions Ensure the highest achievable standards of quality.

Administrator of Specific Services Manage selected national facilities and hospitals with modern facilities. Administer direct services for emergent health concerns Administer health emergency response services .

sustainable and quality health for all Filipinos.Vision and Mission Vision The DOH is the leader. Mission Guarantee equitable. staunch advocate and model in promoting Health for All in the Philippines. especially the poor and shall lead the quest for excellence in health .

Goal: Health Sector Reform Agenda Sound organizational Development Strong Policies Systems and Procedures Capable Human Resources Adequate Financial Resources .

Rationale for Health Sector Reform Following Conditions Slowing down in the reduction Persistence of large variations in health status High burden Rising burden Unattended emerging health risks Burden of disease .

Factors Affecting the Conditions: Inappropriate Health delivery system Inadequate regulatory mechanisms for health services Poor health care financing .

Implications There is poor coverage There is inequality access There is low and high quality cost .

.Framework for Implementation of HSRA: FOURmula ONE for Health Intends to implement critical interventions as a single package backed by effective management infrastructure and financing arrangements following a sectorwide approach.

Goals of FOURmula ONE for Health Better health outcomes More responsive health systems Equitable health care financing .

4. 3. Health financing Health Regulation Health service delivery Good governance . 2.Four elements of the Strategy 1.

Key features of the FOURmula ONE Engagement of the National Health Insurance Program (NHIP) as the main lever to effect desired changes and outcomes in each of the four implementation components .

4. Financing Governance Regulation Service Delivery .NHIP supports each of the elements in term of: 1. 3. 2.

Roadmap for All Stakeholders in Health: National Objectives for Health 2005-2010 NOH 2005-2010 Provides the road map for skateholders in health and health-related sectors to intensify and harmonize their efforts to attain its timehonored vision of health for all Filipinos Sets the targets and the critical indicators. current strategies based on field experinces. and laying down new avenues for improved interventions .

civil society and the communities in making crucial decisions for health . program managers. development partners. local government executives.Provides concrete handle that would guide policy makers.

Objectives of the Health Sectors A. E. B. C. D. Improve the general health status of the population Reduce morbidity and mortality from certain diseases Eliminate certain diseases Promote healthy lifestyle and environmental health Protect vulnerable groups with speacial health and nutrition needs .

F. Institute health regulatory reforms to ensure quality and safety of health goods and services . Pursue public health and hospital reforms H. Reduce the cost and ensure the quality of essential drugs I. Strengthen national and local health systems to ensure better health service delivery G.

Institute safety nets for the vulnerable and marginalized systems L. Improve efficiency in the allocation. Mobilize more resources for health N. Strengthen health governance and management support systems K. Expand the coverage of social health insurance M.J. production and utilization of resources for health .

Post war independence Philippine Health Care System was administered by a central agency based in Manila 2. LGU runs the local health systems .LOCAL HEALTH SYSTEM Historical background 1.Major shift took place in the Local Government Code also known as Republic Act 7160. 1992 .

Objectives Establish local health systems for effective and efficient delivery of health care services Upgrade the health care management and service capabilities of local health facilities Promote inter-LGU linkages and cost sharing schemes Foster participation of the private sector. nongovernment organization (NGOs) and communities in local health systems development .

Ensure the quality of health service delivery at the local level .

A system of health care similar to a district health system in which individuals. communities and all other health care providers in a well-defined geographical area .Inter Local Health Systems Being espoused by the DOH in order to ensure quality of health care service at the local level.

Expected Achievement of the Inter-Local Health System Universal coverage of health insurance Improved quality of hospital and Rural Health Units (RHU) service Effective referral system Integrated planning Appropriate Health Information System Improved Drug Management System Developed human resources .

Effective leadership through Inter-LGU corporation Financially visible or self sustaining hospitals Integration of public health and curative hospital care Strengthened cooperation between LGU and health services .

especially the poor .Guiding Principles In Developing The Inter-Local Health System Financial and Administrative autonomy of the provincial and municipal administrations (LGUs) Strong political support Strategic synergies and partnerships Community participation Equity of access to health services by the population.

Affordability of health services Appropriateness of health programs Decentralized management Sustainability of health initiatives Upholding of standards of quality health service .

4. People Boundaries Health Facilities Health Workers . 2.Composition of the Inter-Local Health Zone 1. 3.

PRIMARY HEALTH CARE AN APPROACH TO DELIVERY OF HEALTH CARE SERVICES .

DEFINITION PRIMARY HEALTH CARE Is an essential care made accessible to the community through acceptable means .

1978 •Organized by the World Health Organization . USSR •Happened on September 6-12.HISTORY “Health for all by Year 2000” •Declared during First International Conference on Primary Health Care •Held in Alma Ata.

HISTORY LETTER OF INSTRUCTION 949 Philippines HEALTH IN THE HANDS OF PEOPLE BY 2020 YxÜw|ÇtÇw XA `tÜvÉá October 19. 1979 .

. the altruistic endeavor has bear fruit as it has produced progress in the lives of people from the communities it has influenced.HISTORY Wespite the failure to realize the goal of Health for All by 2000.

CONCEPTS
PARTNERSHIP + EMPOWERMENT OF PEOPLE = PRIMARY HEALTH CARE

EFFECTIVE ACCESSIBLE ACCEPTABLE SUSTAINABLE

ELEMENTS AND COMPONENTS

1. Environmental sanitation

ELEMENTS AND COMPONENTS

2. Control of Communicable Diseases

ELEMENTS AND COMPONENTS

3. Immunization

ELEMENTS AND COMPONENTS 4. Health Education .

Maternal and Child Health and Family Planning .ELEMENTS AND COMPONENTS 5.

Adequate Food and Proper Nutrition .ELEMENTS AND COMPONENTS 6.

ELEMENTS AND COMPONENTS 7. Provision of Medical Care and Emergency Treatment .

ELEMENTS AND COMPONENTS 8. Treatment of Locally Endemic Diseases .

Provision of Essential Drugs .ELEMENTS AND COMPONENTS 9.

STRATEGIES Reorientation and reorganization of national health care system with the establishment of functional support mechanism. .

.STRATEGIES Effective preparation and enabling process for health action at all levels.

STRATEGIES Mobilization of the people to know their communities and identifying their basic health needs. .

.STRATEGIES Development and utilization of appropriate technology focusing on local indigenous resources available in and acceptable to the community.

.STRATEGIES Organization of communities arising from their expressed needs which they have decided to address.

management.STRATEGIES Increase opportunities for community participation in local level planning. monitoring and evaluation within the context of regional and national objectives. .

STRATEGIES Development of intra-sectoral linkages with other government and private agencies. .

.STRATEGIES Emphasizing partnership so that the health workers and the community leaders/members view each other as partners.

Use of appropriate technology 4. Active community participation 2. Support mechanism made available .FOUR PILLARS/CORNERSTONES 1. Intra and inter-sectoral linkages 3.

TYPES OF WORKERS •Available health manpower resources •Local health needs and problems •Political and financial feasibility .

TYPES OF WORKERS •Physician •Nurses •Midwives •Traditional healers •Community health workers .

General medical practitioners or their assistants.LEVELS OF WORKERS Village or Barangay health workers. Rural sanitary inspectors and midwives . health auxiliary volunteer. Public health nurse. traditional birth attendant or healer Intermediate level health workers. Trained community health workers.

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM .

.PRIMARY LEVEL CARE Devolve to the cities and the municipalities.

SECONDARY LEVEL OF CARE Is given by the physicians with basic health traning. .

TERTIARY LEVEL OF CARE Is rendered by specialist in health facilities including medical centers as well as regional and provincial hospitals and specialized hospitals. .

LEVELS OF HEALTH CARE SERVICES .

National Health Services Medical Centers Teaching Hosptials Regional Health Services Regional Medical Centers And Training Hospitals Provincial / City Health Services Provincial / City Hospitals Emergency / District Hospitals Rural Health Unit Community Hospitals and Health Centers Private Practitioners / Puericulture Centers Barangay Health Stations Levels of Health Care and Referral System .

On Duty • • • • • Marcelino. Johnette Vinluan. Sandi II-AN . Janyss April Pesebre. Justine Pearl Patagoc. Regine Ortua.

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