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Lesson 2
Created Oct 17, 2020

Last read Oct 18, 2020 1125 PM

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Title The Health Care Delivery System

The Health Care Delivery System
Learning Outcomes
Discussion
World Health Organization
Millennium Development Goals
Millennium Development Goals
17 Sustainable Development Goals
SDGs vs MDGs
Philippine Department of Health
Vision
Mission
Historical Background of DOH
General Functions of DOH
2 Sectors of PHCDS
Public Sector
Private Sector
Local Government Units LGUs)
Local Health System and Devolution of Health Services
Local Health System Historical Background
Objectives for Local Health Systems
Inter Local Health System
Classification of Health Facilities DOH AO0012A
Primary Health Care PHC
Elements/Components of PHC
Strategies
Four Cornerstones/Pillars in PHC
Levels of Health Care and Referral System
Universal Health Care
UHC's Three Thrusts

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 The Health Care Delivery System
Learning Outcomes
Relate the concepts of the Philippine Health Care Delivery System through
the millennium development goals and sustainable development goals of
the World Health Organization

Orient on the background of the Philippine Department of Health and the

primary health care.

Discussion

World Health Organization

The WHO trends the global health since 2000 and an assessment of the
challenges for the succeeding 15 years. The health in 2015 identified the
Millennium Development Goals to Sustainable Development Goals.

Millennium Development Goals

In September 2000, the UN Millennium Summit, UN General Assembly adopted
the United Nations Millennium Declaration.

The Declaration called for a global partnership to reduce extreme poverty,

was the first ever global strategy with quantifiable targets to be agreed upon
by all UN member states and the world's leading development institution.

Millennium Development Goals

by UN Secretary General Kofi Annan

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  Eradicate extreme poverty and hunger

 Achieve universal primary education

 Promote gender equality and empower women

 Reduce child mortality

 Improve maternal health

 Combat HIV/AIDS, malaria and other diseases

 Ensure environmental sustainablity

 Develop a global partnership for development

17 Sustainable Development Goals

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  End poverty in all its forms everywhere.

 End hunger, achieve food security and improved nutrition, and promote
sustainable agriculture.

 Ensure healthy lives and promote well-being for all at all ages.

 Ensure inclusive and equitable quality education and promote a lifelong

learning opportunities for all.

 Achieve gender equality and empower all women and girls.

 Ensure availability and sustainable management of water and sanitation for

all.

 Ensure access to affordable, reliable, sustainable and modern energy for

all.

 Promote sustained, inclusive and sustainable economic growth, full and

productive employment and decent work for all.

 Build resilient infrastructure, promote inclusive and sustainable

industrialization and foster innovation.

 Reduce inequality within and among countries.

 Make cities and human settlements inclusive, safe, resilient, and
sustainable.

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  Ensure sustainable consumption and production patterns.

 Take urgent action to combat climate change and its impacts.

 Conserve and sustainably use the oceans, seas and marine resources for
sustainable development.

 Protect, restore and promote sustainable use of terrestrial ecosystems,

sustainably manage forests, combat desertification, and halt and revers
land degradation and halt biodiversity loss.

 Promote peaceful and inclusive societies for sustainable development,

provide access to justice for all and build effective, accountable and
inclusive institutions at all levels.

 Strengthen the means of implementation and revitalize the global

partnership for sustainable development.

SDGs vs MDGs
SDGs MDGs

uniformly applicable to all countries narrow focus on poverty reduction

of the world focus on developing countries with
removing the "developing" vs funding from rich countries
"developed

focused on a global development

with and for sustainability
environment is not an add-on or in
opposition to sustainable
development, but rather a baseline
that underpins all other goals

"Health in 2015 from MDGs to SDGs" came effect last

January 1, 2016

Philippine Department of Health

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 Vision

💡 The DOH is the leader, staunch advocate and model in promoting

Health for all in the Philippines

Mission

💡 Guarantee equitable, sustainable and quality health for all Filipinos,

especially the poor and shall lead the quest for excellence in health.
The DOH shall do this by seeking all ways to establish performance
standards for health human resources; health facilities and institution;
health products and health services that will produce the best health
systems for the country. This, in pursuit of its constitutional mandate
to safeguard and promote health for all Filipinos regardless of creed,
status, or gender with special consideration for the poor and the
vulnerable who will require more assistance.

Historical Background of DOH

🗓 Historical Background of DOH

General Functions of DOH

EO 102

1...Leadership in Health

a. Serve as the national policy and regulatory institution from which the
LGUs, NGOs, and other members of the health sector involved in social
welfare and development will anchor their thrusts and directions for health.

b. Provide leadership in the formulation, monitoring and evaluation of

national health policies, plans and programs.

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 c. Serve as advocate in the adoption of health policies, plans and programs to
address national and sectoral concerns.

2...Enabler and Capacity Builder

a. Innovate strategies to improve effectiveness of health programs;

discussion on health issues; disseminate policy research outputs to ensure
public-participation in policy decision-making.

b. Oversight functions and monitoring and evaluation of national health PPP.

c. Ensure the highest standards of quality health care, promotion and

protection.

3...Administrator of Specific Services

a. Manage selected national & sub-national health facilities and hospitals with
modern and advanced facilities to serve as national referral centers and
referral center for local health systems.

b. Administer direct services for emergent health concerns that require new
complicated technologies that it deems necessary for public welfare.

c. Administer health emergency response services, including referral and

networking system for trauma, injuries, and catastrophic events in cases of
epidemic and other widespread public danger.

2 Sectors of PHCDS
Public Sector
largely financed through a tax-based
budgeting system at both national
and local level and where health care
is generally given free at the point of
service
Private Sector
largely market-oriented and where
health care is paid through user fees
at the point of service
include for profit and non-profit
health providers

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 Includes providing health services in
clinics and hospitals, health
insurance, manufacture of medicines,
vaccines, medical supplies,
equipment, and other health and
nutrition products, research and
development, human resource
development and other health
related services.

Local Government Units (LGUs)

runs the local health system

provincial and district hospitals are under the provincial government

city/municipal government manages the health centers/RHUs and BHSs

Function: to serve as advisory body to the local executive and the

sanggunian or legislative council on health-related matters.

Local Health System and Devolution of

Health Services
Local Health System Historical Background
The Philippines Health Care System was administered by a central agency
based in Manila, this control agency provided the singular sources or
resources, policy direction, technical, and administrative supervision to all
health facilities nationwide.

RA 7160 Local Government Code — all structures, personnel and

budgetary allocations from the provincial health level down to the
barangays were devolved to the LGUs to facilitate health service delivery.

Provincial governments operate the Provincial District Hospitals

City/municipal governments operate the health centers/RHUs and BHSs

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 Objectives for Local Health Systems
 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 including local

health care financing systems for better utilization of local health
resources.

 Foster participation of the private sector, NGOs and communities in local

health systems development.

 Ensure the quality if health care service deliver at the local level.

Inter Local Health System

Espoused by the DOH in order to ensure quality of health care service at
the local level.

Similar to a district health system in which individuals, communities and all

other health care providers in a well-defined geographical area participate
together in providing quality equitable and accessible health care as the
basic framework.

Classification of Health Facilities (DOH

AO-0012A)
ACCORDING TO OWNERSHIP

GOVERNMENT

The hospital is created by law.

A government health facility may be under the National

Government, DOH, LGU, DOJ, SUCs, GOCC and others.

PRIVATE

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 Owned, established, and operated with funds from donation,
principal, investment, or other means by any individual,
corporation, association, or organization.

ACCORDING TO SCOPE SERVICES

GENERAL HOSPITAL

A hospital that provides services for all kinds of illnesses, diseases,

injuries or deformities.

It shall be equipped with the services capabilities needed to

support board certified/eligible medical specialists and other
licensed physicians rendering services in, but not limited to:

↳ Clinical Services (Family Medicine, Pediatrics, Internal Medicine,

Obstetrics and Gynecology, Surgery)

↳ Emergency Services

↳ Outpatient Services
↳ Ancillary and Support Services (Clinical laboratory, Imaging
Facility, Pharmacy)

SPECIALTY

Specializes in particular disease or condition or in one type of

patient

A specialized hospital may be devoted to the treatment of:

↳ Treatment of a particular type of illness or for a particular

condition requiring a range of treatment.

↳ Treatment of patients suffering from a particular diseases of a

particular organ or group of organs.
↳ Treatment of patients belonging to a group such as children,
women, elderly or other.

ACCORDING TO FUNCTIONAL CAPACITY

LEVEL 1. GENERAL HOSPITAL

Shall have as minimum:

 A staff of qualified, medical, allied medical and administrative

personnel headed by a physician duly licensed by the PRC.

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  Bed space for its authorized bed capacity, in accordance with
DOH Guidelines in the Planning & Design of Hospitals.

 An operating room with standard equipment and provisions for

sterilization of equipment and supplies in accordance with:

↳ DOH Reference Plan in Planning and Design...

↳ DOH Guidelines on cleaning, disinfection, and sterilization...

 A post-operative recovery room.

 Maternity facilities consisting of wards, rooms, delivery room

exclusive for maternity patients and newborns.

 Isolation facilities with proper procedures for the care and

control of infection and communicable diseases as well as for
the prevention of cross infection.

 A separate dental section/clinic.

 Provision for blood donation.

 A DOH-licensed secondary clinical laboratory with the services

of consulting pathologist.

 A DOH-licensed level 1 imaging facility with the services of a

consulting radiologist.

 A DOH-licensed pharmacy.

LEVEL 2. GENERAL HOSPITAL

As minimum, all of level 1 capacity, but not limited to:

 An organized staff of qualified and competent personnel with

Chief of Hospital/Medical Director and appropriate board
certified Clinical Department Heads.

 Departmentalized and equipped with the service capabilities

needed to support board certified/eligible medical specialties
and other licensed physicians rendering services in the different
specialties, their subspecialties, and other ancillary services.

 Provision for general ICU for critically ill patients.

 Provision for NICU.

 Provision for HRPU.

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  Provision for Respiratory Therapy Services.

 A DOH licensed tertiary clinical laboratory.

 A DOH licensed level 2 imaging facility with mobile x-ray inside

the institution and with capability for contrast examinations.

LEVEL 3. GENERAL HOSPITAL

As minimum, all of level 2, including but not limited to:

 Teaching and/or Training Hospital with accredited residency

training programs for physicians in the four major specialties:
Medicine, Pediatrics, Obstetrics and Gynecology, and
Surgery

 Provision for physical medicine and rehabilitation unit.

 Provision for ambulatory surgical clinic.

 Provision for dialysis facility.

 Provision for blood bank.

 A DOH licensed level 3 imaging facility with interventional

radiology.

Primary Health Care (PHC)

WHO...

PHC as essential health care made universally accessible 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 can afford at
every stage of development

Declared on September 612, 1978 by WHO during the First International

Conference on PHC held in Alma Ata.

Goal: "Health for all by the year 2000."

Adopted in the Philippines through the Letter of Instruction 949 signed by

President Marcos on October 19, 1979 and has an underlying theme of
"Health in the Hand of the People by 2020."

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 The concept of PHC is characterized by partnership and empowerment of
the people that shall permeate as the core strategy in the effective
provision of essential health services that are community-base, accessible,
acceptable and sustainable at a cost which the community and the
government can afford.

A strategy, which focuses responsibility for the health on the individual,

his family and the community. It includes the full participation and active
involvement of the community towards the development of self-reliant
people, capable of achieving and acceptable.

The recent PHC Summit held on February 2324, 2006 has showcased the
various community managed health activities that has successfully placed
health in the hands of the people in this country.

Level of health and well-being.

It also recognizes the interrelationship between health and the overall

political, socio-cultural and economic development of society.

Elements/Components of PHC
 Environmental Sanitation

 Control of Communicable Diseases

 Immunization

 Health education

 Maternal and Child health and Family Planning

 Adequate food and proper nutrition

 Provision of medical care and emergency treatment

 Treatment of locally endemic diseases

 Provision of essential drugs

Strategies
 Reorientation and reorganization of the national health care system with
the establishment of functional support mechanism in support of the

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 mandate of devolution under the Local Government Code of 1991

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

 Mobilization of the people to know their communities and identifying their

basic health needs with the end in view of providing appropriate solutions
leading to self-reliance and self-determination.

 Development and utilization of appropriate technology focusing on local

indigenous resources available in and acceptable to the community.

 Organization of communities arising from their expressed needs which

they have decided to address and that this is continually evolving in
pursuit of their own development.

 Increase opportunities for community participation in local level planning,

management, monitoring and evaluation within the context of regional and
national objectives.

 Development of intra-sectoral linkages with other government and private

agencies so that programs of the health sector is closely linked with those
of other socio-economic sectors at the national, intermediate and
community levels.

 Emphasizing partnership so that the health workers and the community

leaders/members view each other as partners rather than merely providers
and receiver of health care respectively.

Four Cornerstones/Pillars in PHC

Active community participation

Intra and inter-sectoral linkages

Use of appropriate technology

Support mechanism made available

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 TYPES OF PHC WORKERS THAT VARY IN DIFFERENT COMMUNITIES
DEPENDING UPON

Available health manpower resources

Local health needs and problems

Political and financial feasibility

2 LEVELS OF PHC WORKERS

 Village or Barangay health workers

 Intermediate level health workers

Levels of Health Care and Referral System

 PRIMARY LEVEL OF CARE

The first contact between the community members and the other levels of
health facility

 SECONDARY LEVEL OF CARE

Capable of performing minor surgeries and perform some simple
laboratory examinations.

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  TERTIARY LEVEL OF CARE
Complicated cases and intensive care requires tertiary care and all these
can be provided.

Universal Health Care

Republic Act No. 11223

— automatically enrolls all Filipino citizens in the National Health Insurance

Program and prescribes complementary reforms in the health systems
universal health coverage is foremost a political choice. The UHC Act
embodies this choice and was carried by a broad coalition of parliamentarians
across the political spectrum.

REPUBLIC ACT NO. 11223

AN ACT INSTITUTING UNIVERSAL HEALTH CARE FOR ALL FILIPINOS,

PRESCRIBING REFORMS IN THE HEALTH CARE SYSTEM AND APPROPRIATING
FUNDS THEREFORE THIS ACT SEEKS TO
a. Progressively realize universal health care in the country through a
systematic approach and clear delineation of roles of key agencies and
stakeholders towards better performance in the health system; and

b. Ensure that all Filipinos are guaranteed equitable access to quality and
affordable health care goods and services, and protected against financial
risk.

💡 The Philippines uses Universal Health Care interchangeably with

Universal Health Coverage. It has been an iterative process of health
reform, ongoing for almost 50 years and under different names

Philippines: UNIVERSAL HEALTH CARE LEGISLATION

Objectives:

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 The UHC Bill seeks to realize universal health coverage through a
systematic approach and clear delineation of the roles of key agencies and
stakeholders
The major reform seeks to:
↣ consolidate existing yet fragmented financial flows

↣ increase the fiscal space for benefit delivery

↣ improve the governance and performance of devolved local health
systems
↣ institutionalize support mechanisms such as health technology
assessment and health promotion

UHC's Three Thrusts

To attain UHC, three strategic thrusts are to be pursued, namely:

a. Financial risk protection through expansion in

enrollment and benefit delivery of the NHIP.

b. Improved access to quality hospitals and health care

facilities; and

c. Attainment of health-related Millennium Development

Goals

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