COMMUNITY

HEALTH CARE The Health Care

NURSING I Delivery System
MODULE 2
PHILIPPINE HEALTH CARE
DELIVERY SYSTEM

COMMUNITY HEALTH CARE NURSING I

MODULE 2
  A world in which
everyone can live
healthy, productive lives
 Placing health at the
center of the global
agenda
VISION  Engaging countries and
STATEMENTS strengthening
partnerships
  To oversee global health issues
while leading research
initiatives
 To publicize fact-based policy
MISSION options so all information is
disseminated globally
STATEMENT
 To aid individual countries to
cope with health issues within
their borders
THE ROLE OF  Providing leadership on matters critical
WHO IN
to health and engaging partnership where
PUBLIC
HEALTH joint action is needed;
 Shaping the research agenda and
stimulating the generation, translation and
dissemination of valuable knowledge;
 Setting norms and standards and
promoting and monitoring their
implementation;
 • Articulating ethical and
THE ROLE OF
WHO IN PUBLIC evidence-based policy options;
HEALTH • Providing technical support,
catalyzing change, and building
sustainable institutional
capacity; and
• Monitoring the health situation
and assessing health trends.
MILLENIUM DEVELOPMENT
GOALS 2015
to
SUSTAINABLE DEVELOPMENT
GOALS 2030
 MILLENIUM DEVELOPMENT GOALS 2015

 Signed by 189 United Nation members

countries on September 2000
 Aims to achieve a set of eight measurable
goals that combat poverty, hunger, disease,
illiteracy, environment degradation, and
discrimination against women by 2015.
MILLENIUM DEVELOPMENT 1. To eradicate extreme
GOALS 2015
poverty and hunger;
•

•Target: Halve between 1990 and

2015, the proportion of people whose
income is less than one dollar a day
•Target: Achieve Decent
Employment for Women, Men,
and Young People
•Target: Halve between 1990 and
2015, the proportion of people who
suffer from hunger.
MILLENIUM DEVELOPMENT
GOALS 2015 1. To achieve universal
primary education;
•

•Target: Ensure that by 2015,

children everywhere, boys
and girls alike will be able to
complete a full course of
primary schooling.
MILLENIUM DEVELOPMENT
GOALS 2015
•3. Promote gender equality
and empower women;
•
• Target: Eliminate gender
disparity in primary and
secondary education,
preferably by 2005, and
in all levels of education
by no later than 2015.
MILLENIUM DEVELOPMENT
GOALS 2015 4. Reduce child mortality
rates;
• Target: Reduce by
two-thirds, between
1990 and 2015, the
under-five mortality
rate
MILLENIUM DEVELOPMENT
GOALS 2015 5. Improve maternal health;
• Target: Reduce by three-
quarters, between 1990
and 2015, the maternal
mortality ratio
• Target: Achieve, by 2015,
universal access to
reproductive health
MILLENIUM DEVELOPMENT 6. Combat HIV/AIDS, malaria, and
GOALS 2015
other diseases;
• Target: Have halted by 2015 and
begun to reverse the spread of
HIV/AIDS.
• Target: Achieve, by 2010, universal
access to treatment for HIV/AIDS
for all those who need it.
• Target: Have halted by 2015 and
begun to reverse the incidence of
malaria and other major diseases
MILLENIUM DEVELOPMENT 7. Ensure environmental sustainability;
GOALS 2015 • Target: Integrate the principles of
sustainable development into country
policies and programs; reverse loss of
environmental resources
• Target: Reduce biodiversity loss,
achieving, by 2010, a significant reduction
in the rate of loss.
• Target: Halve, by 2015, the proportion of
the population without sustainable access
to safe drinking water and basic sanitation
• Target: By 2020, to have achieved a
significant improvement in the lives of at
least 100 million slum-dwellers
 8. Develop a global partnership for
MILLENIUM DEVELOPMENT
GOALS 2015 development;
• Target: Develop further an open,
rule-based, predictable, non-
discriminatory trading and
financial system.
• Target: Address the Special Needs
of the Least Developed Countries
(LDCs)
• Target: Address the special needs
of landlocked developing countries
and small island developing States
 8. Develop a global partnership for
MILLENIUM development;
DEVELOPMENT GOALS 2015 • Target: Deal comprehensively with the
debt problems of developing countries
through national and international
measures in order to make debt
sustainable in the long term
• Target: In co-operation with
pharmaceutical companies, provide
access to affordable, essential drugs in
developing countries
• Target: In co-operation with the private
sector, make available the benefits of new
technologies, especially information and
communications
SUSTAINABLE • Officially known as Transforming our world: the
2030 Agenda for Sustainable Development
DEVELOPMENT
GOALS • It is non-binding document released as a result of
Rio + 20 Conference held in June 2012 in Rio de
2030
Janeiro, in Brazil
• Develop a new set of 17 “ Global Goal ” with 169
targets between them
• It will carry on the momentum generated by the
MDGs and fit into a global development framework
beyond 2015 ( Post 2015 Development Agenda
(Successor to the Millennium Development Goals)
• Spearheaded by the United Nations through a
deliberative process involving its 193 Member
States, as well as global civil society.
 SDG 3 – Ensure healthy lives and promote
well-being for all at all ages.
1. Reduce the number of maternal deaths to less than 70 in 100,000 live births.

2. Eradicate preventable newborn and under-five mortality, with each country to cut neonatal
deaths to less than 12 per and under-five mortality to 25 per 1,000 live births.

3. Prevent hepatitis, communicable diseases and water-borne diseases and completely do away
with tuberculosis, AIDS, malaria and other tropical diseases.

4. Reduce the rate of premature deaths from non-communicable infections by one third though
prevention and treatment of the infections.

5. Reduce the abuse of substances such as alcohol and narcotic drugs by ensuring prevention
and treatment centers are available and affordable.
 SDG 3 – Ensure healthy lives and promote
well-being for all at all ages.

6. By 2020, halve the number of global deaths and injuries from road traffic accidents.

7. Ensure access to reproductive and sexual health-care services to everyone.

8. Achieve universal health coverage through access to safe, quality, effective and
affordable vaccines and medicines for all, access to quality basic health care services, and
financial risk protection.

9. Reduce by more than half the rates of illnesses and deaths from harmful chemicals and
water, soil and air pollution and contamination.
 DEPARTMENT OF
HEALTH
• Holds the over all • Its mandate is to
technical authority on develop national
health as it is a plans, technical
national health policy- standards, and
maker and regulatory. guidelines on health.
 1. Leadership in Health;
2. Enabler and Capacity
THREE Builder; and
MAJOR 3. Administrator of
ROLES IN
THE HEALTH
Specific Services
SECTOR
 1. Ensure equal access to basic health services
2. Ensure formulation of national policies for
proper division of labor and proper
coordination of operations among the
government agency jurisdictions
3. Ensure a minimum level of implementation
FIVE MAJOR nationwide of services regarded as public
FUNCTIONS health goods
4. Plan and establish arrangements for the
OF public health systems to achieve economies of
DEPARTMEN scale
5. Maintain a medium of regulations and
T OF HEALTH standards to protect consumers and guide
providers.
 E ducation regarding Health
BASIC L ocal Endemic Diseases

HEALTH E xpanded Program on Immunization

M aternal & Child Health Services
SERVICES E ssential drugs and Herbal Plants

UNDER N utritional Health Services (PD 491): Creation

Nutrition Council of the Philippines.
of

PHC T reatment of Communicable & non communicable

Diseases.
OF S anitation of the Environment (PD 856): Sanitary
DOH Code of the Philippines
D ental Health Promotion
A ccess to and use of hospitals as Centers of Wellness
M ental Health Promotion
PRINCIPLES  EQUITY: equal health services
for all – no discrimination
TO  QUALITY: DOH is after the
ATTAIN quality
 PHILOSOPHY OF DOH: “
THE Quality is above Quantity”
VISION  ACCESSIBILITY: DOH utilize
strategies for delivery of health
OF DOH services
THE PHILIPPINE  “the totality of all policies,
HEALTH CARE
DELIVERY facilities, equipment,
SYSTEM products, human resources
and services which address
HEALTH the health needs, problems
CARE and concerns of the people. it
DELIVERY is large, complex, multi-level
SYSTEM and multi-disciplinary.
THE PHILIPPINE  interrelated system in which a
HEALTH CARE
DELIVERY
country organizes available
SYSTEM resources for the maintenance
and improvement of the health
HEALTH of its citizens and communities.
CARE  the network of health facilities
DELIVERY and personnel which carries out
the task of rendering health care
SYSTEM
to the people.
 WHO SIX BUILDING BLOCKS OF
HEALTH SYSTEMS
LEADERSHIP AND HEALTH FINANCING
GOVERNANCE HUMAN RESOURCES,
SERVICE DELIVERY AND
HEALTH MEDICINE AND
INFORMATION TECHNOLOGIES
 LEADERSHIP AND GOVERNANCE
 Devolution of Health Services
 Refers to the act by which the National Government confers power and authority upon the various Local
Government Units to perform specific functions and responsibilities
 RA 7160 – The Local Government Code of 1991
 The legal basis of devolution
 It devolved the following basic services
 Agriculture, forest management, health services, social welfare, Barangay level roads
 For effective & efficient delivery of health care services
 Promote inter LGU linkages and cost – sharing schemes
 Foster participation of private sectors, NGO etc. in health development
 LGU’s were given increased powers to mobilize their resources
 DOH as Facilitator, LGU as Implementors
 RN must apply in the RHU through the Municipal Health Officers
 LEADERSHIP AND GOVERNANCE
• Context of Devolution in the ARMM
• It has retained the centralized character of health
system
• DOH ARMM directly runs the provincial hospitals and
the municipal health centers
2. SERVICE DELIVERY
• Key Elements in Health Service Delivery
• Organizing health services as networks of primary care
backed up by hospitals and specialized care
• Providing package of health benefits with clinical and
public health interventions
• Ensuring access and quality of services
• Holding providers and ensuring consumer voice.
2. SERVICE DELIVERY
• Classification of Health Facilities (DOH AO 2012-0012)
• According to Ownership
• Government
• Private
• According to Scope of Services
• General Facilities/Hospitals (PGH and Jose Reyes Memorial
Medical Center)
• Specialty Centers/Hospitals (PHC, NKTI)
According to Functional Capacity

Classification of General Hospitals

OLD NEW
LEVEL 1 RE-CLASSIFY TO OTHER HEALTH
FACILITIES
LEVEL 2 LEVEL 1
LEVEL 3 LEVEL 2
LEVEL 4 LEVEL 3
 NEW CLASSIFICATION

HOSPITALS OTHER HEALTH FACILITIES

GENERAL A. Primary Care Facility

• Level 1
• Level 2 B. Custodial Care Facility
• Level 3 (Teaching and
C. Diagnostic Facility
Training)

Specialty D. Specialized Outpatient Facility

3. Human Resources
• Key Elements in Human Resources for Health
• Achieving enough of the right mix of staff
• Ensuring system wide deployment and distribution
• Establishing job related norms and enabling work environments
• Establishing payment systems that produce the right kind of incentives
• Public Health Workers/ Providers (PHW)
• 8 Public Health Workers
• Trends in Health Personnel
3. Human Resources
• Trends in Health Personnel
• Largest Category of health workers in the Philippines: Nurses and Midwifes
• There is underproduction in other categories such as doctors and dentist
• Health Workforce Distribution
• DOH Deployment Programs
• DTTB Doctors to the Barrio- Physician are assigned for 2 years primarily in 4 th
to 6th class municipalities that has not have a doctor for at least 2 years
• Registered Nurses for Health Enhancement and Local Service (RN HEALS)
- Deployed nurses are assigned for 6 months in the community (RHU) and then
another 6 months for hospital service
3. Human Resources
• DOH Deployment Programs
• Rural Health Midwives Program
• Assigned in Brgy. Health Stations and RHU for improved
maternal and childcare to provide Basic Emergency
Obstetric and Newborn Care (BEmONC) or
Comprehensive Emergency Obstetric and Newborn Care
(CEmONC)
• Rural Heath Team Placement Program
4. MEDICINE AND TECHNOLOGIES
•Pharmaceutical Care
•Constraints in accessing Essential Drugs
•Medical Technologies and Devices
5. HEALTH FINANCING
• 4.7 % of GDP (WHO, 2016)
• Low public budget share of health spending
(32.5% of the total)
• Has a high proportion of out pocket spending
• Each Pinoy spent 5,859 for health in 2014
5. HEALTH FINANCING
• Three Major Groups of Payers of Healthcare in the
Philippines
• Government
• Social Health Insurance (NHIP/PhilHealth)
• Private Sources
5. HEALTH FINANCING
• Republic Act 7875 – National Health
Insurance Program act of 1995 amended in
RA 10606 – mandates to cover all Filipinos
Citizens
6. HEALTH INFORMATION

• Health Information in the Philippines

• National Telehealth Service Program
• eMedicine
• eRecords
• eSurveillance
REFERENCE:

• Araceli S. Maglaya, (2004). Nursing Practice in the Community (4th ed). Philippines
• Monina H. Gesmundo
, RN RM MAN, (2010). The Basics of Community Health Nursing; A study Guide for Nursing
Students and Local Board Examinees. Philippines
• DOH, (2008). Public Health Nursing in the Philippines. Philippines
• https://en.wikipedia.org/wiki/World_Health_Organization
• https://www.doh.gov.ph/
• https://www.un.org/sustainabledevelopment/sustainable-development-goals/
• https://www.youtube.com/watch?v=30B1nV9lbao
ACTIVITY 2:

1. Propose at least 5 possible interventions from the

identified targets in Sustainable development goals 3.
Select at least 3 of the targets.
2. Discuss Health Care Delivery System of the
Philippines. (maximum of 1000 words with
Introduction, body and conclusion).
PRIMARY HEALTH CARE (PHC)
• The WHO defines Primary Health Care an
essential health care made universally
acceptable to individuals and families in the
community by means acceptable to them
through their full participation and at a cost
that the community and country and afford at
every stage of development.
• A practical approach to making health
benefits within the reach of all people.
• An approach to health development, which is
carried out through a set of activities and
whose ultimate aim is the continuous
improvement and maintenance of health
status
A brief history of Primary Health Care

• May 1977 -30th World Health Assembly decided that the main health target of the government and
WHO is the attainment of a level of health that would permit them to lead a socially and
economically productive life by the year 2000.
• September 6-12, 1978 – First International Conference on PHC in Alma Ata, Russia (USSR) The
Alma Ata Declaration stated that PHC was the key to attain the “health for all” goal
• October 19, 1979 – Letter of Instruction (LOI) 949, the legal basis of PHC was signed by Pres.
Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and
implementation of programs focusing on health development at community level.
Rationale for Adopting Primary Health Care

• Magnitude of Health Problems

• Inadequate and unequal distribution of health resources
• Increasing cost of medical care
• Isolation of health care activities from other development activities
 O B J E C T I V E S O F P R I M A RY H E A LT H C A R E
MISSION
• Improvement in the level of health care of the
• To strengthen the health community
• Favorable population growth structure
care system by increasing • Reduction in the prevalence of preventable,

opportunities and communicable and other disease.

• Reduction in morbidity and mortality rates especially

supporting the conditions among infants and children.

• Extension of essential health services with priority

wherein people will given to the underserved sectors.

• Improvement in Basic Sanitation
manage their own health • Development of the capability of the community aimed
at self- reliance.
care. • Maximizing the contribution of the other sectors for the
social and economic development of the community.
K E Y S T R AT E G Y TO A C H I E V E T H E
G O A L O F P R I M A RY H E A LT H C A R E
GOAL:
• Key Strategy to Achieve the Goal: • HEALTH FOR ALL FILIPINOS by the year
2000 AND HEALTH IN THE HANDS OF
• Partnership with and Empowerment THE PEOPLE by the year 2020.
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, which the community and the
government can afford.
Principles of Primary Health Care

• 4 A’s = Accessibility, Availability, • Partnership between the community and the

Affordability & Acceptability health agencies in the provision of quality of
• Community Participation life.

• People are the center, object and subject of • Recognition of interrelationship between the

development. health and development

• Self-reliance • Social Mobilization

• Decentralization
 E ducation regarding Health
Elements L ocal Endemic Diseases

of E xpanded Program on Immunization

M aternal & Child Health Services
Primary E ssential drugs and Herbal Plants
Nutritional Health Services (PD 491): Creation of
Health Nutrition Council of the Philippines.
Care T reatment of Communicable & non communicable
Diseases.
S anitation of the Environment (PD 856): Sanitary
Code of the Philippines
Dental Health Promotion
Access to and use of hospitals as Centers of Wellness
M ental Health Promotion
FOUR CORNERSTONES/PILLARS IN
P R I M A RY H E A LT H C A R E
• Active Community Participation
• Intra and Inter-sectoral Linkages
• Use of Appropriate Technology
• Support mechanism made
available
M A J O R S T R AT E G I E S O F P R I M A RY H E A LT H
CARE
• Elevating Health to a Comprehensive and
Sustained National Effort
• Promoting and Supporting Community
Managed Health Care
• Increasing Efficiencies in the Health Sector
• Advancing Essential National Health
Research
TRAINING OF HEALTH WORKERS

• 3 Levels of Training

Grassroot/Village
• Includes Barangay Health Volunteers (BHV) and Barangay Health Workers (BHW)
• Nonprofessionals didn’t undergo formal training, receive no salary but are given incentive in
the form of honorarium from the local government since 1993
Intermediate
• these are professionals including the 8 members of the PHWs

First Line Personnel

• the specialist
  This is done by preventing exposures to hazards that cause
LEVEL OF disease or injury, altering unhealthy or unsafe behaviors that can
lead to disease or injury, and increasing resistance to disease or
PREVENTION injury should exposure occur.
 Directed towards individuals who are at Risk of developing a
disease or those who are in the pre-pathogenic stage
 Deals with the removal of risk factors or specific protection of
Primary Prevention individuals against these risk factors

• aims to prevent
Examples include:
disease or injury  Safe and healthy practices (e.g. use of seatbelts and bike helmets)
before it ever  Education about healthy and safe habits (e.g. eating well,
exercising regularly, not smoking)
occurs.  Immunization against infectious diseases.
 Food supplementation and malaria chemoprophylaxis
 LEVEL OF  This is done by detecting and treating disease or injury as soon as
PREVENTION possible to halt or slow its progress, encouraging personal strategies to
prevent re-injury or recurrence, and implementing programs to return
people to their original health and function to prevent long-term
problems.
 Directed towards individuals in the subclinical stage, asymptomatic
Secondary Prevention and symptomatic stage of a disease.
 Aims to diagnose and treat existing health problems at the earliest
• aims to reduce the possible time and to limit disabilities attributed to it.
impact of a disease
or injury that has Examples include:

already occurred.
• Regular exams and screening tests to detect disease in its earliest
stages (e.g. mammograms to detect breast cancer)
• Diet and exercise programs to prevent further heart attacks or strokes
• Case findings, surveillance, and treatment of communicable diseases.
 LEVEL OF  This is done by helping people manage long-term, often-complex
PREVENTION health problems and injuries (e.g. chronic diseases, permanent
impairments) in order to improve as much as possible their ability to
function, their quality of life and their life expectancy.
 Directed towards individuals in the pathogenic stage of the disease

Tertiary  Deals with the reduction of the magnitude and severity of the
residual effects of communicable and non-communicable diseases.
Prevention Examples include:
 aims to soften the  Cardiac or stroke rehabilitation programs, chronic disease management
programs (e.g. for diabetes, arthritis, depression, etc.)
impact of an
 Support groups that allow members to share strategies for living well
ongoing illness or  Control of spread of measles during an epidemic.
injury that has
lasting effects.
UNIVERSAL HEALTH CARE
• Republic Act No. 11223 also referred to as “Kalusugan Pangkalahatan”
• “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
• 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)/SDGs.
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 about health care
expenditures.
IMPROVED ACCESS TO QUALITY HOSPITALS AND
HEALTH CARE FACILITIES

• Improved access to quality hospitals and health facilities shall be achieved in several 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.
ATTAINMENT OF HEALTH-RELATED MDGS

• Further efforts and additional resources are to be • RN heals nurses will be trained to become trainers
applied on public health programs to reduce maternal and supervisors to coordinate with community-level
and child mortality, morbidity and mortality from workers and CHTs.
Tuberculosis and Malaria, and incidence of
• By the end of 2011, it is targeted that there will be
HIV/AIDS.
20,000 CHTs and 10,000 RNheals.
• Localities shall be prepared for the emerging disease
• Another effort will be the provision of necessary
trends, as well as the prevention and control of non-
services using the life cycle approach.
communicable diseases.
• These services include family planning, ante-natal
• The organization of Community Health Teams (CHTs)
care, delivery in health facilities, newborn care, and
in each priority population area is one way to achieve
the Garantisadong Pambata package.
health-related MDGs.
• CHTs are groups of volunteers, who will assist
• Better coordination among government agencies,
families with their health needs, provide health such as DOH, DepEd, DSWD, and DILG, would
information, also be essential for the achievement of these MDGs.
PHILIPPINE HEALTH AGENDA 2016 - 2022

• President Rodrigo Duterte has recently released the Philippine Health Agenda 2016-2022, which strengthens the Duterte Health Agenda, “All for
Health towards Health for All”. This health system, through the Department of Health, aspires financial protection, better health outcomes and
responsiveness for all Filipinos.

In order to attain health-related sustainable development goals, the A.C.H.I.E.V.E. strategy is followed:
• 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

With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a health system with the values of Equity, Quality, Efficiency, Transparency,
Accountability, Sustainability, Resilience towards “Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat”.
Reference:
• Araceli S. Maglaya, (2004). Nursing Practice in the Community (4th ed). Philippines
• Monina H. Gesmundo, RN RM MAN, (2010). The Basics of Community Health Nursing; A study
Guide for Nursing Students and Local Board Examinees. Philippines
• DOH, (2008). Public Health Nursing in the Philippines. Philippines
• https://www.doh.gov.ph/kalusugang-pangkalahatan
• https://www.officialgazette.gov.ph/downloads/2019/02feb/20190220-RA-11223-RRD.pdf
• https://www.doh.gov.ph/sites/default/files/basic-page/Philippine%20Health%20Agenda_Dec1_1.pdf
• https://www.slideshare.net/faboritoz/philippine-health-agenda-2016-2022