Primary

Health Care
(PHC) in the
Philippines
 Introduction

Primary Health Care (PHC) is 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 can afford at
every stage of development.
 DEFINITIONS:

World Health Organization (WHO)

• 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.
Alma Ata Declaration
• The Declaration of Alma-Ata was adopted at
the International Conference on Primary
Health Care (PHC), Almaty (formerly Alma-
Ata), Kazakhstan (formerly Kazakh Soviet
Socialist Republic), 6-12 September 1978
Eight essential elements based on
the Alma Ata on PHC:
An essential health care based on practical,
scientifically sound and socially acceptable methods
and technology made universally, accessible to
individuals and families in the community by means
of acceptable to them, through their full participation
and at a cost that community and country can afford
to maintain at every stage of their development in the
spirit of self-reliance and self-determination.
Eight essential elements based on
the Alma Ata on PHC:

Treatment of Expanded
Maternal and Child
Health Education Locally Endemic Program on
Health
Diseases Immunization

Treatment of
communicable and Safe water and
Provision of
Nutrition non- good waste
Essential Drugs
communicable disposal
diseases
 GOAL OF PHC

The ultimate goal of primary

health care is better health for
all. WHO has identified five key
elements to achieving that goal:
 Five Key Elements to Achieve the Goal

1. Reducing exclusion and social disparities in health

(UNIVERSAL COVERAGE REFORMS);

2. Organizing health services around people’s needs and

expectations (SERVICE  DELIVERY / REFORMS);

3. Integrating health into all sectors (PUBLIC

POLICY REFORMS);

4. Pursuing collaborative models of policy

dialogue (LEADERSHIP REFORMS); and

5. Increasing stakeholder participation.

 History
May 1977. The 30th World Health Assembly adopted resolution which decided
that the main social target of governments and of WHO should be the attainment
by all the people of the world by the year 2000 a level of health that will permit
them to lead a socially and economically productive life.

September 6-12, 1978. International Conference in PHC was held in this

year at Alma Ata, USSR (Russia)

October 19, 1979. The President of the Philippines (Ferdinand Marcos) issued

Letter of Instruction (LOI) 949 which mandated the then Ministry of Health to adopt PHC as an
approach towards design, development, and implementation of programs which focus health
development at the community level.
Adopting primary health care has
the following rationales:

4. Isolation of
2. Inadequate
health care
1. Magnitude of and unequal 3. Increasing
activities from
Health distribution of cost of medical
other
Problems health care
development
resources
activities
 Objectives of PHC
1. Improvement in
2. Favorable
the level of health
population growth
care of the
structure
community

3. Reduction in the 4. Reduction in

prevalence of morbidity and
preventable, mortality rates
communicable and especially among
other disease. infants and children.
 Objectives of PHC

5. Extension of essential
health services with 6. Improvement in basic
priority given to the sanitation
underserved sectors.

8. Maximizing the
7. Development of the contribution of the other
capability of the sectors for the social
community aimed at and economic
self- reliance. development of the
community.
 Types of PHC workers

There are two types of primary health care workers in

the Philippines:
1. Barangay Health Worker or Village
Health Worker
2. Intermediate level Primary Health
Worker
Four Pillars of PHC

Active Intra and

Community Inter-
Participatio sectoral
n linkages

Support
Use of
mechanism
appropriate
made
technology
available
 Major Strategies

1. Elevating health to a 2. Promoting and

comprehensive and supporting community
sustained national effort managed health care

3. Increasing efficiency in 4. Advancing essential

health sector national health research
 Principles of PHC
Primary health care is run with the following principles:
1. 4 A’s = Accessibility, Availability, Affordability &
Acceptability, Appropriateness of health services.
The health services should be present where the supposed
recipients are. They should make use of the available
resources within the community, wherein the focus would be
more on health promotion and prevention of illness.
 Principles of PHC
2. Community Participation
Barriers of Community Involvement
1. Lack of motivation
2. Attitude
3. Resistance to change
4. Dependence on the part of community people
5. Lack of managerial skills
 Principles of PHC
3. People are the center, object and
subject of development.
4. Self-reliance
5. Partnership between the community
and the health agencies in the provision
of quality of life.
 Principles of PHC

6. Recognition of interrelationship
between the health and
development
7. Social Mobilization
8. Decentralization
INTER-LOCAL HEALTH SYSTEM
 INTER-LOCAL
HEALTH SYSTEM
INTER-LOCAL HEALTH SYSTEM
Espoused by the DOH to ensure quality of
health care service at the local level
Individuals, communities and all other health
care providers in a well-defined geographical
area participate together in providing
equitable and accessible healthcare with
inter LGU partnership
INTER-LOCAL HEALTH ZONE (ILHZ)

Defined population

Number of primary level

facilities e.g. Rural Health Defined
Units (RHU) and Barangay geographical area
Health Station (BHS)

Central referral
hospital
 Expected Achievement of the Inter
Local Health System
Universal Improved quality
Effective referral Integrated
coverage of the of Hospital and
system planning
Health Insurance. RHU service

Appropriate Effective
Improved drug
health Developed leadership
management
information human resources through Inter-
system
system LGU cooperation

Financially Integration of Strengthened

visible /self- Public Health & cooperation
sustaining curative hospital between LGU and
hospitals care health sectors.
 Composition of the ILHZ
1. People – according to WHO the ideal health
district would have a population size between
100,000 and 500,000 for optimum efficiency and
effectiveness.
2. Boundaries – clear boundaries between ILHZ
determine the accountability / responsibility of
health service providers, geographical locations
and access to referral facilities.
3. Health facilities - district hospitals, RHU, BHS
 Composition of the ILHZ
4. Health workers that plan joint strategies for district health
care.
a. DOH
b. District Hospitals
c. Rural Health Units
d. Barangay Health Stations
e. Private Clinics
f. Volunteer Health Workers
g. Non-Government Organization
h. Community-based Organization
 LEVELS OF HEALTH CARE AND
REFERRAL SYSTEM

I. PRIMARY LEVEL OF CARE

devolved to cities and municipalities
Provided by center physicians, Public Health Nurses,
Rural Health Midwives, BHW, Traditional Healers
First contact between the community members
and other levels of health facility
II. SECONDARY LEVEL OF CARE
care given by physicians with basic health training
Given in health facilities wither privately owned or
government operated – district hospitals or out-patient
department of provincial hospitals
Referral center for primary health facilities
Capable of performing minor surgeries and
perform simple laboratory examinations
III. TERTIARY LEVEL OF CARE
Rendered by specialists in health facilities including
medical centers, regional and provincial hospital, and
specialized hospitals e.g. Philippine Heart Center
Referral center for the secondary care facilities.
Complicated cases and intensive care requires
tertiary care
LEVELS OF HEALTH CARE AND REFERRAL
SYSTEM National
Health
Services,
Medical
Centers,
Teaching
and Tertiary
Training
RegionalHospitals
Health Services,
Regional Medical Centers &
Training Hospitals

Provincial / City Health Services ,

Provincial / City Hospitals
Secondary

Emergency / District Hospitals

Rural Health Unit Community Hospitals and Health Centers, Primary

Private Practitioners

Barangay Health Stations

THE MILLENNIUM DEVELOPMENT GOALS

UN General Assembly decided to adopt a common

vision of poverty reduction and sustainable
development in September 2000.
This vision is exemplified by the Millennium
Development Goals (MDG’s) based on the fundamental
values of freedom, equality, solidarity, tolerance,
health, respect for nature and shared responsibility.
THE MILLENNIUM DEVELOPMENT GOALS

Eradicate Achieve Promote

extreme universal gender equality
poverty and primary and empower
hunger education women

Combat
Reduce child Improve HIV/AIDS,
mortality maternal health malaria and
other diseases

Develop a
Ensure
global
environmental
partnership for
sustainability
development
 HEALTH SECTOR REFORM
AGENDA
FOURmula One:
the framework for health sector reform as a means to
achieving the Millennium Development Goals
Goals:
FOURmula ONE for Health as Overall Frame

Better Health
Outcomes

More
Equitable Responsive
Health Care Health
Financing Systems
FOURmula ONE for Health:
Elements of the Strategy
Good
Governance -
Health Service Improved health
system
Delivery- Improve performance at
accessibility and
Health availability of basic
the national and
Regulation- and essential local levels
ensure quality & health care for all,
Health affordability of especially the poor.
Financing- goods and
greater, better services
& sustained
investment in
health