PHILIPPINE

HEALTHCARE

DELIVERY

SYSTEM

TRENDS  ISSUES  CHALLENGES
RYAN MICHAEL F. ODUCADO, MAN, MAEd,
RN, RM, RPT
Lead Faculty, Community Health NursingWest Visayas State University
NNCCS, Master Trainer (Community/Public Health Nursing)

Seminar Outcome
After 30-minute seminar, the participants must
have:
1. identified the various trends, issues and
challenges confronting the Health Care Delivery
System contextualizing the discussion in the
Philippine setting;
2. recognized the pivotal role of nurses in
addressing these key issues and challenges; and
3. participated attentively in the exchange of
intellectual discussion in identifying possible
areas for improvement, research and knowledge
development in the area of health care system.

Declaration of

Interest

&

Disclosure

The presentation covers data available to the
public.

The presenter is a Master in
Community/Public Health Nursing working
collaboratively with the Department of
Health.

The presenter has projects geared toward
increasing Education, Nursing and Public
Health body of knowledge.

The presenter has no known or perceived
conflict of interest.

Content Outline
Pressures on the Public Health System (Cuevas, 2007)
1. Shift in demographic and epidemiologic trends in disease
Emerging disease like EBOLA, MERSCov, ZIKA

2. New technologies for health care, communication and
information
RxBOX, mhGAP, eHealth, EVP, BPO

3. Existing and emerging environmental hazards with
globalization
Climate Change, Disaster Preparedness

4. Health Reforms
SDGs, Duterte Health Agenda, ASEAN Integration

Content Outline
1. National Health Situation
2. Local Health Situation
3. Global Health Goals
4. National Health Goals

Philippine Health Care Delivery
System
It is a complex set of organizations interacting to provide an array of health
services.

Public

Private

Largely financed through tax-based system

Largely market-oriented

National
DOH

Local
LGU

Specialty, retained and
regional hospitals,
medical centers, DOH
representatives

Provincial and district
hospitals, RHUs, BHSs

Profit
Commercial,
market
orientation

Non-profit
Non-commercial,
service
orientation

Private practitioners,
private clinics and

Socio-civic groups,
religious organizations, or

Demographic and Epidemiologic Trends
• Has experienced considerable improvements in
its health status for the past 50 years, yet also
decline in the recent years (Cuevas, 2007)
• Experiencing epidemiologic shift
While contending with the burden of communicable diseases, it is
also the same time contending with non-communicable diseases.

Threatened
whammy”

with

devastating

effect

of

“triple

Philippine National Health Situation

•Highest occurrences of deaths were among the elderly
persons, 70 years and over.
•Death occurrence was least among age group 10-14 years.
•Deaths among under 1 year old is more than twice the
number of deaths in ages 1-4 years.
•Statistics show that the risk of dying is directly proportional
to age, starting with age 10 and up.

•CALABARZON, NCR & Central Luzon: Deaths from
these three regions comprised to almost 40 percent
(39.1%) of the total deaths.
•ARMM, CAR and CARAGA: These three regions were
consistently low in terms of the number of deaths
registered, which maybe a result of either effective
health intervention or under registration.

•For several years now, statistics show that even in NCR, a highly urbanized
region and where both public and private health facilities are accessible, still, a
low percentage of attended death is recorded.
•Dying without the attention of a medical doctor could be somehow an evidence
of unaffordable health cost in the country.

•More than 81 percent of deaths registered in
2013 were attributed to the top 10 leading
causes of death for the year.
•Diseases of the Heart had been consistently
the number one cause of death for several
years now.
•Diseases of the Vascular System, Malignant
Neoplasm and Pneumonia remained in their
respective rankings for the past 4 years .

•7 out of the 10 leading causes of deaths were
male dominated.
•Men were almost 4 times more likely to die
from Accidents than women. 

•More deaths from the leading causes were not medically attended.
•9 out of the 10 ten killer diseases were not attended by a medical doctor or
any allied health officer in anytime during their illness or injury.

Health Situation
in

Western Visayas
Renilyn P. Reyes,MD,MPA,DPPS
Head, Family Health and Nutrition Cluster
Sarabia Manor Hotel, Iloilo City
October 21, 2016

Department of Health-Regional Office VI

Total Population
(Projected 2015)

7,603,147
No. of
households

- 1,604,323
Total No. of
Brgys.

- 4,051
Total No. of BHS

- 2,059
Department of Health – Regional Office VI

CRUDE BIRTH and CRUDE
DEATH RATE
Crude Birth Rate

20
17.88

15

Western Visayas, CY 2010-2015
17.19

18.18

18.22

17.46

16.88

16.24

Percentage

10
5

5.55

5.47

5.91

6.12

6.09

5.82

5.97

0
2009

2010

2011

2012

2013

2014

2015
Source:

Department of Health – Regional Office VI

Population:
7,603,147

Top Ten
Leading Causes of
TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Morbidity
Causes
Female
Total
Western
Visayas, Male
CY 2015
1. Upper Respiratory Tract
Infection

61,743

71,206

132,94
9

2. Acute Lower Respiratory Tract
Infection & Pneumonia

20,789

22,253

43,042

3. Bronchitis / Bronchiolitis

11,127

18,752

29,879

9,734

15,402

25,136

14,287

9,808

24,095

6. Urinary Tract Infection

5,336

11,320

16,656

7. TB, All forms

8,037

4,652

12,689

8. Skin Diseases, All forms

4,413

4,413

8,981

9. Acute Watery Diarrhea

2,821

2,821

5,681

10. Diabetes Mellitus

1,801

1,801

4,498

4. Hypertension
5. Injuries, All forms

Department of Health – Regional Office VI

Top Ten
Leading Causes of
TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Mortality
Western Visayas,
CY 2015
Hypertensive Cardiovascular
Diseases (HCVD)
Pneumonia
Malignant Neoplasm (Cancer)
Injuries/Accidents
Kidney Diseases
Tuberculosis, All forms
Septicemia
Cerebrovascular Accident (CVA)
Diabetes
Chronic Obstructive Pulmonary Disease (COPD)

2252
2,158
1876

588
1346
947
1353
596
787
693
795
649
687
746
940
367
0
2,000

6394
5,280
4724
4,175

Population:
7,603,147

4,000

Department of Health – Regional Office VI

6,000

8,000

Infant and Under 5 Mortality
TOP TEN LEADING CAUSES OF MORBIDITY
Rates
WESTERN
VISAYAS, 2015
live births
Westernper1,000
Visayas,
CY 2015
14.00
12.00

11.56
10.00
8.00

9.87

10.13

9.62

9.63

2011

2012

2013

2014

10.27

6.00
4.00
2.00
0.00

2010

2015

Year
There was a slight increase in the Infant Mortality Rate (IMR) of the region from 9.63 deaths per 1,000
live births in 2014 to 10.27 deaths per 1,000 live births in 2015. Between 2010 and 2015, IMR decreased
by 11% from 11.56 in 2010 to 10.27 in 2015.

Infant
Mortality Rate
TOP TEN LEADING CAUSES OF MORBIDITY

WESTERN Western
VISAYAS, 2015 Visayas,
per province / HUCs
25
2015

20

19.1
15.1

15
Rate per 1,000 live births

13.8

13

10.6

10

MDG
Target
CY 17/1,000
LB

10.3
7.3

7.8

7.4

5
0

Iloilo City posted the highest IMR with 19.13 deaths per 1,000 live births.
Antique was at second with 15.06 and Bacolod was third at 13.82. On the
other hand, Capiz recorded the lowest IMR at 7.29. Overall, majority of the
LGUs had IMRs higher than the region.

Under
Five Mortality Rate
TOP TEN LEADING CAUSES OF MORBIDITY

30

WESTERN Western
VISAYAS, 2015 Visayas,
per province / HUCs
2015

MDG Target
25.5/1,000
CY
LB

24.5

25

22.8

Rate per 1,000 live births
20
18.4
15
10

13.8

12.4

14.1

13.5
11.1

10

5
0

Iloilo City and Bacolod had the highest Under Five Mortality Rate in 2015 at
24.47 and 22.76, respectively while Negros Occ. was the lowest at 10.92.

100

FullyTOPImmunized
Child (FIC)
TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Coverage
(%)
Western Visayas, CY 2010-2015

80

80.57
60

85.73
73.67

82.41

73.39

Target
95%

67.06

40
20
0

2010

2011

2012

2013

2014

Year
Department of Health – Regional Office VI

2015

TARGET :
Maternal Mortality Ratio (MMR)
NOH/ MDG (by 2015) : <52/100,000 LB
SDG ( by 2030): -< 70 /100,000 LB
TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN
VISAYAS, 2015
Western Visayas, CY
2010-2015

100
80

77.55
Per 100,000 live births

60

76.80

82.74

90.01
72.87

71.33

40
20
Maternal
Mortality Ratio (MMR) increased from 71.33 per
100,000 live births in 2012 to 90.01 per 100,000 live births in
2014.0 Though it decreased to 72.87 per 100,000 live births in
2015, this was not enough to achieve the MDG target of 52.

2010

2011

2012

2013

2014

Year
Department of Health – Regional Office VI

2015

TARGET :
NOH/ MDG (by 2015) : <52/100,000 LB
SDG ( by 2030): -< 70 /100,000 LB
TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015

Maternal Mortality Ratio (MMR)
Per province/HUCs , CY 2015
200

174.2

180
160
140

138.8

120
100

94.1

92.5

80
60
40

72.3
42.4
17.7

20
0

72.9

0

In 2015, Bacolod City recorded the highest MMR at 174.22 maternal
deaths per 100,000 live births while Guimaras had the lowest with
zero maternal deaths. Three other LGUs namely Aklan, Antique and
Iloilo City had MMRs higher than the region.

Department of Health – Regional Office VI

Births Attendant
by Skilled Health
TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Professional
TARGET : 90%
Facility Based Deliveries
100.00
Western 84.85
Visayas,87.28
CY 2015
89.30

90.40

90.00
81.24
78.42
88.85
80.00
87.34
83.59
79.33
70.00
73.34
60.00
66.21
Percentage
50.00
40.00
30.00
90.40% of all births in the region were attended by Skilled
Health Personnel.
The proportion of births attended by
20.00
skilled health personnel increased from 78.42 in 2010 to 90.4
10.00
per cent in 2015.
0.00
2010
2011
2012
2013
2014
2015
Year

Skilled Birth Attendants
Facility Based Deliveries
Department of Health – Regional Office VI

Facility TOP
Based
Deliveries (%) TARGET : 90%
TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Per province/HUCs
, CY 2015
120
100
80

78.7

83.1

86.9

90.3

86.9

89.8

95.3

99.9
88.9

60
40
20
0

In 2015, more than three fourths (88.85%) of all births were delivered in a
health facility. This is higher than the 87.34% reported in 2014 and a significant
improvement from the 66.21% reported in 2010. Delivery in a health facility
was highest in Iloilo City at 99.9 percent and lowest in Aklan at 78.69 percent.

Department of Health – Regional Office VI

Contraceptive
Prevalence Rate
TOP TEN LEADING CAUSES OF MORBIDITY
TARGET : 65%
WESTERN VISAYAS, 2015
(%)
60.00
Western Visayas, CY 2010- 2015
50.00
40.00

34.13

34.17

40.21

37.85

43.82

47.66

30.00
20.00
10.00
0.00

2010

Current use of contraception among married women in the
region has been increasing for the last five years. In 2015,
around 48 percent of married women were currently using a
modern family planning method, an increase of around four
percentage points from the 2014 CPR of 43.82 percent. From
2010-2015, there has been an increase of around three
percent annually in the region’s CPR.

2011

2012

2013

2014

Year

Department of Health – Regional Office VI

2015

TB Mortality Rate by Province and Highly
TOP TEN LEADING CAUSES OF MORBIDITY
WESTERN VISAYAS, 2015
Urbanized
City
28.00
Western Visayas,
CY 2015
TARGET : < 23 /100,000
27.50
27.00

27.08

26.00
Rate per 100,000 Population

25.94

25.00
24.00
23.00
22.00
21.00

The number of deaths caused by TB has
increased in the region from 1,728 in
2014 to 1,949 in 2015. This translated to
a TB Mortality Rate of 25.6 per 100,000
population, higher than the mortality rate
of 24.57 in 2014. TB Mortality Rate has
decreased by around two deaths per
100,000 population between 2010 and
2015.

2010

2011

2012

24.57

25.60

2014

2015

23.33

2013

Year

Department of Health – Regional Office VI

Mortality Rate from Rabies
1,000,000
Population
TOP TENper
LEADING
CAUSES
OF MORBIDITY
WESTERN VISAYAS, 2015

Western Visayas, CY 2010- 2015
2.50

2.25

TARGET : less than 1/million population
1.97

2.00
1.50

1.24
1.09

1.33

1.00
0.50
0.13

0.00

2010

2011

2012

2013

2014

Year

Department of Health – Regional Office VI

2015

No. of HIV/AIDS Cases
TEN LEADING CAUSES OF MORBIDITY
WesternTOP
Visayas,
CY 2010-2015
WESTERN VISAYAS,
2015
400

377

The estimated prevalence of HIV in the region is still low
350 but growing. The current incidence of HIV/AIDS in the
region is still within the MDG target of less than 1
300 percent of the total population in 2015. However, there
has been an overwhelming increase in the number of HIV
and AIDS cases in the region for the past five years from
250
only 43 new cases in 2010 to 377. Between 2014 and
Case
2015, the number of new HIV cases also increased by 53
200 percent from 247 new cases in 2014 to 377 in 2015. 176

247
193

149

150

89

100
42

50
0

336

58

43

61

2010

27

10

3

1

99

2011

2012
Year

2013

54

2014

HIV
Department of Health – Regional Office VI

41
2015

AIDS

Global & National Health Goals

A

set of goals to end poverty, protect
and ensure prosperity for all.

the

planet,

Each goal has specific targets to be achieved over the next 15
years.
For the goals to be reached, everyone needs to do their
part: governments, the private sector, civil society and
people like you.

Maraming
Salamat!

RYAN MICHAEL F. ODUCADO