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PHILIPPINE HEALTH

DELIVERY CARE SYSTEM


and
HEALTH SECTOR
REFORM AGENDA

Isabelita M. Samaniego MD
Session Objectives

◆ 1. To describe the Philippine Health


situation.
◆ 2. To describe the role of the DOH in the
health care delivery system.
◆ 3. To describe the effect of devolution .
◆ 4. To describe the impact of the programs on
maternal & child health.
◆ 5. To describe the Health situation in the
City of Manila
The Philippines

7,100 islands
1,700 LGUs
1 unitary/national
government
General Health Status of
the Filipinos
◆ LifeExpectancy: 68.6 yrs
◆ Female: 71.28 ; Male: 66.03
◆ Highest: Central Luzon
Southern Tagalog
◆ Lowest: ARMM & Eastern Visaya
◆ Impact:
❖ Higher proportion of elderly in general
population
❖ Need to increase health & other socioeconomic
inputs in some regions
Crude Birth Rate
❖ 28.9/1000 population (1946)
❖ 30.5 (1950)
❖ 24.8% (1972 lowest)
❖ 30.7 (1973 - 1979)
❖ Sex ratio: 109:100 (male)
Crude Death Rate
❖ 1946 to present - steady decline
❖ 1959 lowest decline - 7.3/1000
❖ 1960 to 1990 - slow but steady
decline
❖ Death Rates: (highest) infancy &
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early childhood, decline by age
10 and sharp rise by age 40
❖ Male death rate: 5.6/1000
❖ Female death rate - 3.9/1000
Total Fertility Rate
❖ Averagenumber of births that a
woman would have at the end of
her reproductive life

❖ Important in assessing impact of


family planning and reproductive
behavior
❖ TFR highest in Asia
❖ 1995-97: 3.7 children/woman
❖ varies with education and location
❖ Urban: 3 children/woman
❖ Rural: 4.7 children/woman
❖ without education & with
Elementary education: 5/woman
❖ High school: 3.64/woman
❖ College: 2.9/woman
IMR = # of deaths below 1 yr xF
# of live births
Infant Mortality Rate
❖ Philippines high compared to
Thailand, Singapore, Brunei, Japan
❖ Rapid decline from 1970 to 1990
(62 & 36.8)
❖ Varies with socioeconomic &
demographic factors
◆ Rural - 40.2 ; Urban - 340.9
◆ MetroManila - lowest;
◆ Eastern Visayas - highest
◆ High IMR
❖ low educational status
❖ no antenatal and post natal care
❖ <20 y/o & >40 y/o
❖ male , small or very small infants
❖ birth order of 7 and above
❖ previous birth interval <2 years
❖ Respiratory and Pneumonia (most
common cause)
◆ Impact of High IMR
❖ improvement of maternal and
child health care
❖ uplifting socioeconomic
conditions
MMR =deaths
= among women directly due to
pregnancy &puerperium
Total live births
◆ Maternal Mortality Rate
❖ Death of a woman during
pregnancy, at childbirth or in
the period after child birth
❖ An indicator of nation’s health
❖ 1970 - 190/100,00 births
❖ 1995 - 2nd to Indonesia
179/100,000
❖ Lifetime risk of dying from
maternal cause is 1:100
◆ Causes of Maternal Deaths
❖ postpartum bleeding
❖ hypertension
❖ sepsis
❖ obstructed labor
❖ complications from abortion
TEN LEADING CAUSES OF MORBIDITY
    No. & Rate/100,000 Population
      PHILIPPINES, 2002
MALE FEMALE BOTH SEXES
CAUSE Rate** Rate** Number Rate*

1. Pneumonias 931.1 881.7 734,581 924.0

2. Diarrheas 881.1 842.7 726,310 913.6

3. Bronchitis/Bronchiolitis 748.1 798.8 629,968 792.4

4. Influenza 565.9 622.7 484,388 609.3

5. Hypertension 339.8 427.3 304,690 383.2

6. TB Respiratory 161.0 113.6 114,221 143.7

7. Diseases of the Heart 58.2 67.0 52,237 65.7

8. Malaria 53.5 42.6 39,994 50.3

9. Chickenpox 33.8 35.6 28,600 36.0

10. Measles 30.5 29.0 24,639 31.0

                Source:
2002 FHSIS Annual Report
                 ** rate/100,000 of sex-specific population
TEN LEADING CAUSES OF MORTALITY BY
SEX
Number, Rate/100,000 Population &
Percentage
Philippines, 2002
Both Sexes
Male Female
Cause Number Rate Percent*

1. Heart Diseases 39,502 30,636 70,138 88.2 17.7

2. Vascular System C:\WINDOWS\hinhem.scr


27,536 21,983 49,519 62.3 12.5
Diseases

3. Malignant
20,440 18,381 38,821 48.8 9.8
Neoplasm

4. Pneumonia 16,729 17,489 34,218 43.0 8.6

5. Accidents 27,448 6,169 33,617 42.3 8.5

           Source:
2002 Philippine Health Statistics
           * percent share from total deaths, all causes,
Philippines
TEN LEADING CAUSES OF MORTALITY BY
SEX
Number, Rate/100,000 Population &
Percentage
Philippines, 2002
Both Sexes
Cause Male Female
Number Rate Percent*

6. Tuberculosis, all
19,293 9,214 28,507 35.9 7.2
forms

7. COPD and allied


13,007 6,313 19,320 24.3 4.9
conditions

8. Certain conditions
originating in the 8,520 5,689 14,209 17.9 3.6
perinatal period

9. Diabetes Mellitus 6,524 7,398 13,922 17.5 3.5

10. Nephritis,
nephritic syndrome 5,358 3,834 9,192 11.6 2.3
and nephrosis

Source: 2002 Philippine Health Statistics


         
           * percent share from total deaths, all causes,
Philippines
DISEASE PATTERNS

• Environmental and
Occupational Issues
Battle
Of
The Bugs
Main Causes of Maternal
Mortality
◆ 1. neonatal delivery & other complications
related to pregnancy occurring in the course
of labor delivery & puerperium.
◆ 2. Hypertension complicating pregnancy ,
child birth & puerperium
◆ 3. Post partum hemorrhage
◆ 4. Pregnancy with abortive outcome
◆ 5. Hemorrhage related to pregnancy
DISEASE PATTERNS

◆ Smallpox ◆ Ebola
◆ Poliomyelitis ◆ AIDS
◆ Malaria ◆ Variant
Creuzfelds-
◆ TB jacob
◆ Pneumonia ◆ SARS
◆ Influenza ◆ Bird Flu
Ten Leading Cause of
Infant Mortality
◆ 1. Respiratory conditions of the fetus & the newborn
◆ 2. Pneumonia
◆ 3. Congenital anomalies
◆ 4. Diarrheal diseases
◆ 5. Birth injury & difficult labor
◆ 6. Septicemia
◆ 7. Meningitis
◆ 8. Avitaminosis & other nutritional disorders
◆ 9. Other diseases of the respiratory system
◆ 10 Measles
Health Care Delivery System

◆ Significant
Milestones in public
health care delivery system (25
years)
❖ Adoption of Primary Health Care in
1979
❖ Integration of public health and
hospital services in 1983 (EO 851)
❖ Reorganization of DOH in 1987
(EO 119)

❖ Devolutionof health services in


1992 to LGUs (Local Government
Code of 1991 (RA 7160)

❖ Streamliningof DOH’s organization


and functions (EO 102)
Department of Health
(DOH)
◆ Lead agency
◆ Specialty and regional hospitals, and
medical center
◆ Regional field office in regions
◆ Provincial health teams involved in
controlling malaria and schistosomiasis
◆ Devolution of health services to LGUs
❖ Provincial and district hospitals
-Provincial government
❖ Municipal health units and barangay
health units - Municipal government
❖ Private Sectors have important roles
in the provision of health services
◆ Clinics and hospitals
◆ HMO
◆ Manufacture of drugs, medicines &
vaccine
◆ Medical supplies & equipment
◆ R & D ; HRD ; health related services
  Vision
  The leader of health for all in the Philippines

  Mission
  Guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor, and
to lead the quest for excellence in health.
Overview of the General Health
Status of Filipinos points to
several Principles to
Improved Health
1 . Universal access to basic health
services must be ensured

2 . The health and nutrition of


vulnerable groups must be
prioritized.
3 . The epidemiologic shift from
infectious to degenerative must
be managed.

4. The performance of the health


sector must be enhanced.
GOALS
1. Improve the general health
status of the population:
◆ Reduce infant mortality rate
◆ Reduce child mortality rate
◆ Reduce total fertility rate
◆ Increase life expectancy and quality of
life years
GOALS
2 .Reduce morbidity, mortality,
disability and complications from
the following diseases and
disorders:
❖ Diarrheas and other food and water
borne diseases like typhoid, cholera
and hepatitis A
❖ Pneumonia and acute respiratory
infections
❖ Tuberculosis
❖ Dengue
❖ Intestinal parasitism
❖ Sexually transmitted diseases,
HIV/AIDS, and other reproductive
tract infections
❖ Hepatitis B
❖ Dental caries and other periodontal
diseases
❖ Rheumatic heart disease and
rheumatic fever
❖ Coronary heart disease,
hypertension and dyslipidemia
❖ Stroke
❖ Cancer
❖ Diabetes mellitus
❖ Asthma and chronic obstructive
pulmonary diseases
❖ Nephritis and other kidney diseases
❖ Mental disorders
❖ Protein-energy malnutrition
❖ Iron deficiency anemia
❖ Obesity
❖ Accidents, trauma, and injuries
◆ 3.Eliminate the following
diseases as public health
problems.
❖ Schistosomiasis, malaria,
filariasis, Rabies, Leprosy
❖ Vaccine preventable diseases:
measles, tetanus, diphtheria and
pertussis
❖ Vitamin A deficiency and iron
deficiency diseases
◆ 4. Eradicate poliomyelitis

◆ 5. Promote Healthy life style


❖ Promote healthy diet and nutrition
❖ Promote physical activity and fitness
❖ Promote personal hygiene
❖ Promote mental health &less stressful life
❖ Prevent smoking & substance abuse
❖ Prevent violent & risk-taking behavior
◆ 6.Promote the Health and Nutrition
of families & special population
❖ Neonatal & infant health
❖ Children’s health
❖ Adolescent and youth health
❖ Adult’s health
❖ Women’s health
❖ Health of older people
❖ Health of indigenous people
❖ Health of overseas Filipino workers
❖ Health of the disabled persons
❖ Health of the rural and urban poor
Strategies
◆ Increasing investments for Primary
Health Care
◆ Development of National Standards
and objectives for health
◆ Assurance of the Quality of Health
Care
◆ Support to the Local Health System
Development
◆ Support for frontline Health Workers
Department of Health Profile 
(Thrust for 2004)
◆ The Department of Health (DOH) is the 
principal health agency in the Philippines

◆ Responsible for ensuring access to basic 
public health services to all Filipinos through 
the provision of quality health care and
regulation of providers of health goods and
services.
◆ DOH Role
❖ stakeholder in the health sector,  and 
❖ a policy and regulatory body for health

◆ As a Major Player
❖ technical resource
❖ a catalyzer for health policy
❖ a political sponsor; and 

❖ advocate for health issues in behalf of the 
health sector.
DOH Offices

◆ 17 central offices

◆  16 Centers for Health Development 
located in various regions

◆ 70 hospitals;  and 

◆ 4 attached agencies.
Central Office
◆ Office of the Secretary and five major 
function clusters
◆Staff support services
–Health Emergency Management Staff
– Internal Audit Staff, 
– Media Relations Group 
– Public Assistance Group 
–Major Zonal Offices (Luzon, Visayas 
and Mindanao.) 
Zonal Office
◆ Undersecretary (head)  supported by an 
Assistant Secretary.

◆ Mandated to coordinate and monitor 
the implementation of the  ff:
–Health Sector Reform Agenda
–National Health Objectives 
– Local Government Code with the various 
Centers for Health Development
◆Sectoral Management Support 
Cluster
–Health Human Resource Development 
Bureau 
–Health Policy Development and Planning 
Bureau. 
◆Internal Management Support 
Cluster
–Administrative Service
– Information Management Service
–Finance Service
–Procurement and Logistics
◆Health Regulation Cluster 
– Bureau of Health Facilities and Services
– Bureau of Food and Drugs 
– Bureau of Health Devices and Technology. 

◆External Affairs Cluster 
–Bureau of Quarantine and International 
Health Surveillance
– Bureau of International Health Cooperation 
– Bureau of Local Development
Health Program 
Development Cluster
◆ National Center for Disease Prevention 
and Control
◆  National Epidemiology Center
◆ National Center for Health Promotion 
◆  National Center for Health Facilities 
Development. 
Center for Health Development
◆ Responsibilities
❖ field operations of the Department in its 
administrative region 
❖ providing catchment area with efficient and 
effective medical services. 
◆ Tasks
❖ implement laws, regulation, policies and 
programs.
❖ coordinate with regional offices of the other 
Departments, offices and agencies as well as with 
the local governments.
Attached Agencies
◆ The Philippine Health Insurance Corporation 
❖  implement the national health insurance law, 
administers the medicare program for both 
public and private sectors. 
◆ The Dangerous Drugs Board 
❖ coordinates and manages the dangerous drugs 
control program. 
◆ Philippine Institute of Traditional Medicine
◆ Alternative Health Care and the Philippine 
National AIDS Council.
◆Health Regulation Cluster 
– Bureau of Health Facilities and Services
– Bureau of Food and Drugs 
– Bureau of Health Devices and Technology.
◆ External Affairs Cluster 
–Bureau of Quarantine and International 
Health Surveillance
– Bureau of International Health 
Cooperation 
– Bureau of Local Development
Health System Characteristics
(Mainstream)
◆ Observations on Philippine Health Care
System - 1992, Solon
❖ Underinvestment in Health
❖ Unequal access to health services
❖ Inefficiencies in health services utilization
❖ Regressive tax structure

Health Investments
Health System Characteristics . . .

◆ DOH efforts to achieve


technical excellence and
equity
❖ capability to deliver health
services that are technically
excellent at the tertiary level
❖ strong service orientation at all
levels of health service delivery
❖ a functional structure of health
services at all levels of
government up to the barangay
level
WHO-DOH Study, 1995
Health System Characteristics . . .

◆ high public acceptance of the DOH


◆ DOH commitment to devolution
Devolved Personnel, Budget and Facilities
Department of Health
1992

PERSONNEL FACILITIES
BUDGET

78,080 HOSPITAL        - 639
P 10.227 B
RHU/MHC/BHS - 12,580

DEVOLVED RETAINED DEVOLVED RETAINED DEVOLVED RETAINED 


HOSPITAL - 595 HOSPITALS & 
RHU/MHC/BHS SANITARIA
12,580 50

46,080 32,000 P 4.215 P 6.012 B


Comparative Cost of Devolved 
Health Functions by LGU Type
(in Billion Pesos)
Total Cost of Devolved Health Fuinctions - P 4.1 B
Percentage to Total Cost of Devolved Functions - 65.42%

Provinces
59%
P
2.441
B
Municipalities
38%
Cities P 1.583 B
3%
P 0.109
B
DOH Devolved Cost Compared to 
Other Agencies
(in Billion Pesos)

Other DOH
Agencies
66%
(DA, DSWD,
DENR, etc.) P 4.1 B
34%

P 2.1 B
DOH Structure (Pre-devolution)
Office of the Secretary of Health

Executive Committee for 
National Field Operations

15 Regional 
Field Offices
Regional Hosp.
Medical Centers
Sanitaria
Provincial Health 
Offices

Provincial 
Hospitals District 
Health 
Offices

City Health  District 
Offices Municipal 
Medicare &  Health 
Municipal  Offices
Hospitals

BHSs
Health Structure (1993, Post-
devolution)
Office of the Secretary of Health

Executive Committee for 
A Devolved to
Prov’l Gov’t
National Field Operations
B Devolved
to City Gov’t
15 Regional 
Field Offices
C Devolved to
Regional Hosp. Municipal
Gov’t
Medical Centers
Sanitaria
Provincial Health 
Offices
Provincial 
Hospitals District 

A
Health 
Offices

City Health  District 
Offices Municipal 
Medicare &  Health 
Municipal 

B
Offices

C
Hospitals

BHSs
Comparing Governance to Health
Structure
EXECUTIVE BRANCH PUBLIC HEALTH SYSTEM
OFFICE OF THE PRESIDENT NATIONAL  HEALTH SECRETARY
LEVEL
NATIONAL  NATIONAL  NATIONAL  NATIONAL  OFFICE  OFFICE FOR  OFFICE FOR  OFFICE  OFFICE OF 
GOV’T  GOV’T  GOV’T  GOV’T  FOR  HOSPI- TALS  STAN-  FOR  THE CHIEF 
AGENCIES AGENCIES AGENCIES AGENCIES PUBLIC  &  DARDS AND  MANAGE- OF STAFF
HEALTH  FACILITIES  REGULA- MENT 
SERVICES SERVICES TIONS SERVICES

REGIONAL HEALTH 
REGIONAL LEVEL OFFICE

PROVINCIAL  PROVINCIAL 
GOV’T LEVEL HEALTH  OFFICE

CITY GOV’T  CITY HEALTH 
OFFICE
LEVEL
DISTRICT OFFICE

MUNICIPAL GOV’T  RURAL HEALTH 
UNIT
LEVEL
BARANGAY OR  BARANGAY 
HEALTH STATION
VILLAGE LEVEL
The Administration of
Decentralization in Health
◆ Phasing of devolution process
❖ Changeover and Transition period to take 5 years
◆ DOH and LGUs assumed a relationship
based on a “partnership”
◆ Assignment of representatives to LGUs
supervised by a central assistance and
monitoring service.
◆ Defining new roles and functions under
devolution; preparation of a strategy paper
Changeover to Stabilization

Changeover Transition Stabilization


Phase Phase Phase

• Formal • Assisting LGUs • Fully


transfer of autonomous
• Assuring health
personnel, LGUs that
services are not
assets and manage local
disrupted
liabilities health services
from the • Building the
• DOH fully
NGA to LGUs Capability of
exercising its
LGUs to manage
new functions
health services
• DOH
restructuring
DOH Mechanisms for
Partnership
◆ Comprehensive Health Care
Agreements
◆ Health Development Fund
◆ Regional Field Offices as Technical
Resource and Health Human
Resource Development Centers
◆ Quick Health Response System
A Comprehensive Health
.

Care Agreements (CHCAs)


◆ Articulates the roles and
responsibilities in the
implementation of
priority health programs
◆ Province or city shall be
designated as program
coordinator
◆ LGUs to provide
counterpart funding
CHCA ...
◆ Provinces will be responsible for insuring
compliance by their municipalities with
these agreements
◆ Failure in compliance will result in partial or
full suspension of the agreement
◆ Negotiations will be initiated with the
exchange of an indicative CHCA package
with the LGUs local area-based health plan
◆ DOH and LGU shall reconcile plans at the
beginning of the fiscal year
B. Health Development
Fund (HDF)
◆ an anti-poverty
investment package
for health to assist
LGUs, NGOs, POs and
the basic sector

◆ fund intended to
support community-
based health programs
HDF ....
◆ to be treated as trust fund by
LGUs
◆ covered by a MOA; LHB
resolution is a prerequisite
◆ Provincial Health Board to
integrate all HDF-related
projects
◆ DOH to prepare guidelines for
utilization
C. DOH Regional Field Offices
as Technical Resource and
Health Human Resource
Development Centers
◆ RFOs serve as technical resource
management centers directing the
flow and utilization of DOH-
provided assistance to LGUs
Role of RFOs

◆ assess area-based plans of LGUs


◆ negotiate, conclude and monitor CHCAs
with LGUs
◆ recommend HDF allocations
◆ mobilize technical and administrative
assistance
◆ generate monitoring reports
Technical Resource and
Health Human Dev’t
◆ Training programs for
local health personnel
shall be
comprehensive
◆ LGUs to provide
schedules of trainings
to LGUs
◆ Cost-efficiency in
training will be a
consideration
D. Quick Health Response
System
◆ to be based at RFOs and CO and consists of
a preventive element (Disaster Management
Units) and a ready health team (STOP
Death)
◆ DOH reps to LHBs shall provide the link to
QHRS; make initial assessment
◆ DOH to declare an epidemic or public
health emergency in consultation with
LGUs
Quick Health Response ...

◆ DOH to provide assistance even without a


formal request from LGU
◆ DOH may provide continuing assistance
though joint management by the higher
LGU or DOH
◆ Continuing consultation during the
duration of the joint management
New Roles and Functions

◆ Health Policy Development


◆ Guidelines, standard setting, and
development of manuals of operation
◆ Licensing and Regulation
◆ Promulgation of national standards,
goals, priorities and indicators
◆ Development of special health programs
and projects
◆ Advocacy for health legislation
◆ National health campaigns
Reorganized Structure
OFICE OF T HE
SECRE TARY Attached Agencies

Public Relations Unit Specialty Hospitals

Health Emergency Mgt. Staff Internal Audit

Health Human Resource Bureau Health Policy Dev’t and Planning Bureau

Admi Service Info. Mgt. Service Finance Service Procurement and 


Logistics Service

Health  External Affairs Health Operations


Regulations

Centers for Health Dev’t

Regional Hospitals, Medical Centers and 
Sanitaria
ORGANIZATIONAL
STRUCTURES IN THE LOCAL
GOVERNMENT UNITS
Local Development Council
◆ Executive Health
Agenda as Sanggunian
determined by
the Local Chief Personnel Division
Executives and Budget Division
the Local Health
Office Administrative Division
◆ Legislative Health Planning Division
Agenda as
determined by
the Committee on
LHB Other Offices with Health Related
Concerns
Health of the - Office of the Treasurer
Local Sanggunian - Local Finance Council
- Population Office
◆ NGO/Private
- DSWD
Sector/Communit
y Health agenda - DENR
as determined by OUTPUTS: - DECS
the Private - Local Health Plan
Sectors, NGO - Program
Representative Priorities,
Resource
◆ DOH Policies, Allocation
Programs, - Support Systems
Priorities through and
DOH Resources to
Representative Health Plan
- CHCA
Lessons from five years of
decentralization
◆ Pay attention to geography, because political
administration by local governments is
governed by constituencies.
◆ Decentralization is a process.
◆ Decentralizing hospitals results to greater
complexities in adapting to local government
protocols
◆ Equity in resource distribution; commensurate
to burden of responsibilities transferred
LGU Resources for Health
Billions of Pesos
80
IRA
70
Requirement
60 Total Earmarked for Health
50
40
30
20
10
0
1992 1993 1994 1995 1996 1997
Year
Amount Required for Local Health
Services versus Total Earmarked
for Health
Billions of Pesos

Year
Lessons ...
◆ Strategies for ensuring equity for
health workers and local government
units should be in place.
❖ allocation of resources and assistance based on
LGUs relative financial capabilities to fund
devolved functions

DOH uses the DFB Ratio (Devolution


Financing Burden Ratio) as a basis for
allocating resources and assistance to LGUs
• Health Development Fund
• Comprehensive Health Care Agreement
• Financial Augmentation for Health Workers’
Benefits
Relative Financial Capability of
LGUs to Fund Devolved Functions
DFB 
Provinces Municipalities Cities Total
Category

A 43 258 0 301
B 23 973 1 997
C    4 222 64 290
TOTAL      *70  * 1453       65     1588
* excluding ARMM Provinces, Municipalities and Cities
DFB Categories Interpretation
A LGU needing the most assistance form the National Government
B LGU can partially cover CODEF from its IRA resources
C LGU is financially capable of financing all obligations
Lessons ...

◆ Decentralization requires that


pronouncements are made
authoritatively and consistently.
◆ During the transition process, local and
national health agencies must reach
agreement on complementation of health
services and technical assistance.
◆ an agency, before it is decentralized, has
to have a vision and assign units and
managers to accomplish it
What lies ahead
◆ Continuation of some major problems
❖ inadequate financial base for devolved functions
❖ collateral actions working as a counter-stream to
decentralization
◆ Changes in administration may result
to changes in policies as well -
recentralization?
But, devolution can still work.

Recentralization
Decentralization
ROLE OF PHYSICIAN

PATIENT

FAMILY

COMMUNITY

PROFESSION

HIMSELF

RESPONSIBILITIES
FOCUS OF CARE

◆ The Patient in Context


of the Family
◆ The Family Unit
◆ The Community as it
affects The Family
◆ Skilled Clinician
◆ Coordinator of Care
◆ Resource to a Defined
Population
CHALLENGES IN HEALTH CARE
◆ Broader Perspectives in Health: Global
and Local Challenges
◆ People Empowerment in Health &
Community Participation
◆ Environment
MOBILIZING FOR HEALTH
◆ Empower Individuals, Families and
Communities
◆ Promotes Wellness and Health
Maintenance
◆ Sensitized citizenry, aware beneficiary and
Community eager to participate
Student Activity

◆ Describe the 6 goals of the DOH to solve the


health problems of the nation.
◆ Describe 4 strategies to attain the goals .

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C:\WINDOWS\hinhem.scr
FC:\WINDOWS\hinhem.scr