Western Mindanao State University

College of Nursing
Zamboanga City

NCM 112 B:
IN PARTIAL
FULFILLMENT FOR
RELATED LEARNING
EXPERIENCE
SUBMITTED TO:
PROF. EMILIE J. TAN, RN, DNS

SUBMITTED BY:
SITTI HAJAR P. AUKASA
BSN-3B
TOPIC 1. Status of the Philippine Health Care System

According to WHO, “health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity”. Health was earlier said to be the body's
capacity to work well. As time progressed, however the concept of health evolved as well. It
cannot be adequately emphasized that the key thing after which all else follows is wellbeing. All
else falls into place as you preserve good health. The Status of the Philippine Health Care
System has been on a rough edge because of the outbreak of this COVID-19 virus. It tested how
our government and the people behind Department of Health (DOH) to plan on how to stop the
spread of this virus.

One of the current issues we are facing right now is this COVID-19 virus. Coronavirus
disease 2019 (COVID-19) is characterized as a disease caused by a new coronavirus now known
as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2; previously known as
2019-nCoV). The first human cases of COVID-19, a disease caused by COVID-19's novel
coronavirus, were subsequently identified. SARS-CoV-2 was first recorded in December 2019
by officials in Wuhan City, China. In early December 2019, retrospective inquiries by Chinese
authorities reported human cases with the onset of symptoms. While some of the earliest known
cases had a link in Wuhan to a wholesale food market, some did not. Either street vendors,
marketplace workers, or regular customers of that same market are most of the primary patients.
In December 2019, environmental samples were taken from this market positively identified for
SARS-CoV-2, hence indicating that the Wuhan City market had been the origin of these
outbreaks or played a significant role in initially amplifying the outbreaks. On 1 January 2020,
the market was forced to close.

On 30 January 2020, the first case of a coronavirus (2019-nCoV, now COVID-19) in the
Philippines was confirmed in a 38-year-old woman who arrived from Wuhan. Two days later, on
February 1, 2020, the Philippines registered its first death outside of China. On 09 March,
following an increase in new confirmed cases and local transmission, the Philippines government
declared a health emergency. The step they did was to release funds to local governments and
health officials to cope with any additional rise in cases. Because of this, the government decided
to put the country in lockdown. Curfew, check-points and travel restrictions were implemented.
Business and school activities were suspended indefinitely. People were forced to stay in their
homes but they can go outside if it is necessary like buying foods or medicines.

The impact of this pandemic has been affecting the world in many different ways.
Millions of companies have to deal with the economic challenges. Almost half of the world's 3.3
billion workers are in danger of losing their livelihoods. Jobs in the informal sector are incredibly
susceptible because the majority lack access to quality health care and social services and have
lost access to productive assets. Many are unable to feed themselves and their families without
the ability to gain an income during lockdowns. For most, no income means no food, or, at best,
less food and less nutritious food. Nevertheless, the health care units have been one of the most
affected by this pandemic. From lacking of medical supplies to thousands of great nurses and
doctors dying because of COVID-19. If we keep on losing them what would happen to our
health care system?

The rapid incidence of the virus created problems for healthcare systems and forced
healthcare workers to cope with clinical and non-clinical stressors, including personal protective
equipment and facilities shortage, having to deal with physical and mental exhaustion, COVID-
19-related mortality and morbidity, fear and the possibility of losing a coworker. Due to the
increased risk of exposure to the virus, our frontline doctors, nurses and healthcare workers fear
that they may contract COVID-19 themselves. They worry about bringing the virus home and
passing it on to loved ones and family members such as the elderly parents, new born and
immune compromised relatives. Consequently, it suggests that it created significant short- and
long-term effects on the mental health of the healthcare workers. They have to deal with the
patients with COVID-19 virus all by themselves, having to take care of them because the family
couldn’t be there for the patient. The time they spent on duty; having to wear the PPE the whole
day, the sleepless nights they have to give up, and they even experience prejudice or violence by
their own countrymen, thus added to the factors the gave them weariness.

Shortages of personal protective equipment (PPE), gloves, medical masks, respirators,

goggles, face shields, gowns and apron are leaving healthcare workers dangerously ill-equipped
to care for COVID-19 patients. The World Health Organization (WHO) has warned that life is at
risk of mounting damage to the global supply of PPE. They said a critical shortage was generated
by increasing demand, panic buying, hoarding and misuse. These shortages of supplies were also
one of the major problems our healthcare workers have faced. They have reuse their N95 mask
and they thought creatively on how to provide for PPE. Truly, nursing is an art. Even when face
with uncertainties, the resiliency of the Filipino showed. Many people have donated to these
hospitals for them to keep their body safe from the virus. But also, because of this resiliency the
government was in favor this, for them to corrupt.

In addition, the significant impact of COVID 19 has created an opportunity for health
system to evolve in new ways and rapidly adapt to new normal. This pandemic has shed light on
the importance of good infrastructure in health care sector. We should apply positive changes
from pandemic and work hard to achieve financial stability in near future. Every effort must be
done to address long awaited health policies issue so that no more devastation happens in future
subsidies from the government to address the disruption.

Furthermore, on 19 September 2019, an outbreak of polio was declared in the

Philippines. Children in the Philippines are at risk of lifelong paralysis because of this outbreak.
The first case was confirmed on 14 September; the case-patient is a 3-year-old girl from Lanao
del Sur in the southern Philippines. The virus isolated is genetically linked to VDPV2 previously
isolated from environmental samples in Manila and Davao. This indicates that the virus is
circulating. The second case was confirmed on 19 September and is a 5-year-old boy from
Laguna Province, approximately 100 km south-east of Metro Manila.

The Department of Health (DOH) confirms that polio in the Philippines is re-emerging,
nineteen years after the World Health Organization (WHO) declared the country polio-free in
2000. DOH, in close coordination with local government units and concerned national agencies,
and with the support of WHO, the United Nations Children’s Fund (UNICEF), and other
partners, is preparing a rapid response to the polio outbreak. This includes a series of
synchronized oral polio vaccinations to protect every child under the age of 5 years in areas at
risk beginning in October 2019. The DOH is also working with partners to strengthen
environmental and Acute Flaccid Paralysis surveillance throughout the country to detect
poliovirus.

Overall, it may be said that with this virus surrounding us we must take care of ourselves.
COVID-19 affected our lives in many different ways both emotionally and physically. The
impact it made to our healthcare system. The lives we lost. The things we lost. Also, the outbreak
of Polio which made us think of why did it occur again – on what factor did we lack in our
healthcare system. The significance of these diseases made us rapidly take actions and plan out
on what are the best way we could to prevent this from spreading. As the saying goes,
“prevention is better than cure.”
TOPIC 2. Determinants of Health

In our homes, schools, places of work, neighborhoods, and communities is where health
begins. We recognize that taking care of ourselves by eating healthy and being active, not
smoking, having the recommended immunizations and screening tests, and seeing a doctor all
affect our health when we are sick. Our health is also partly influenced by access to social and
economic opportunities; the services and help available in our homes, neighborhoods, and
communities; the quality of our education; the protection of our workplaces; the cleanliness of
our water, food and air; and the essence of our relationships and social interactions. The
conditions in which we live partly explain why some Filipinos are healthier than others and why
Filipinos are not as healthy as they might be more generally.

Social determinants of health are conditions in the environments in which people are
born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and
quality-of-life outcomes and risks. They affect a broad variety of wellbeing, working, and
quality-of-life outcomes, also known as social and physical determinants of health. Conditions in
these various environments and settings like schools, churches, workplace, and neighborhood
have been referred to as “place.” In addition to the more material attributes of “place,” the
patterns of social engagement and sense of security and well-being are also affected by where
people live. Resources that enhance quality of life can have a significant influence on population
health outcomes. Examples of these resources include safe and affordable housing, access to
education, public safety, availability of healthy foods, local emergency/health services, and
environments free of life-threatening toxins.

A primary approach to attaining health equity is to address social determinants of health.

Health equity is when everyone has the chance to reach their full health potential and because of
their social position or other socially determined circumstances, nobody is disadvantaged from
achieving this potential. Social determinants of health such as poverty, unequal access to health
care, lack of education, stigma, and racism are underlying, contributing factors of health
inequities. Furthermore, the WHO made guide on how to address the issues in social
determinants; 1) improve the conditions of daily life—the circumstances in which people are
born, grow, live, work, and age; 2) tackle the inequitable distribution of power, money, and
resources—the structural drivers of those conditions of daily life—globally, nationally, and
locally; lastly, measure the problem, evaluate action, expand the knowledge base, develop a
workforce that is trained in the social determinants of health, and raise public awareness about
the social determinants of health.

Politics, for better or worse, plays a critical role in health affairs. Political determinants,
means analyzing how different power constellations, institutions, processes, interests, and
ideological positions affect health within different political systems and cultures and at different
levels of governance. Bambra et al, provide three arguments why health is political, health is
unevenly distributed, many health determinants are dependent on political action, and health is a
critical dimension of human rights and citizenship. Politics have been interfering with health in
the past years. If you look at it, people in the lower classes receives less benefits regarding to
their rather than those in the higher ups. Quality of care between the two classes was an evident
that politics do really interfere with health.

Health economic determinants have been widely recognized as important health factors;
however, no systematic study has been performed to date to summarize these factors and the
ways in which they can impact health. The economy is conceptualized as a complex system
consisting of fundamental approaches, institutional regulation, markets, finance, labor, public-
private balance, as well as production and distributional effects that have a collective impact on
health through the effect of moderators.

The economy also effects health care organizations and practitioners. There is evidence
that the stagnation has kept patients from seeking inpatient and elective services, and that
physicians and institutional providers are seeing more patients who are unable to pay for their
care because they are uninsured or underinsured. Hospitals have reported scaling back on capital
improvements, including upgrades and new clinical and information technology. The effects of
economic contractions run counter to the sustained growth in the health sector.

Research on the effects of economic cycles on health is perplexing. A number of studies

have found that health outcomes, as measured by mortality rates, are countercyclical, that is,
mortality rates are worse (higher) when the economy gets better. But economic downturns have
also been linked to markedly higher rates of cancer deaths and homicides, and to a wide range of
psychiatric disorders as well as alcohol and substance abuse.

Hence, several modifiable environmental factors—such as outdoor air pollution,

household air pollution, drinking water contamination, occupational exposure to hazardous
materials, lead exposure, and built environments that discourage physical activity—influence the
risk and experience of chronic disease. The World Health Organization estimates that 21.2% of
global deaths and 16.3% of global disability-adjusted life years lost are attributable to these risk
factors. There are several approaches for estimating the number of deaths and chronic illnesses
attributable to these factors. Managing and mitigating environmentally related chronic illness
begins with the administration of an environmental health history.

The WHO estimates that 13–32% of the global disease burden is attributable to these
environmental determinants. Thus, approximately 83 million people still do not have adequate
sanitation systems of which 15.6 million people still practice open defecation and 28 million do
not have access to improve sources of safe drinking water, resulting in about 30 thousand
preventable deaths each year; hazardous chemical risks, such as exposure to toxic pesticides,
lead, and mercury tend to disproportionally impact children and pregnant women; environmental
changes such as climate change increasingly have an impact on people’s health and well-being in
the Region by disrupting physical, biological, and ecological systems globally. Extreme weather
events have exacerbated food insecurity, air pollution, access to clean water, population
migration and transmission patterns of vector-borne illnesses. The health effects of these
disruptions may include increased respiratory, cardiovascular, and infectious disease; injuries;
heat stress and mental health problems.
 Many factors combine together to affect the health of individuals and communities.
Whether people are healthy or not, is determined by their circumstances and environment. To a
large extent, factors such as where we live, the state of our environment, genetics, our income
and education level, and our relationships with friends and family all have considerable impacts
on health, whereas the more commonly considered factors such as access and use of health care
services often have less of an impact.

It is the interrelationships among these factors that determine individual and population
health. The context of people's lives determines their health, and so it is inappropriate to blame
people for having poor health or credit them for good health. Individuals are unlikely to be able
to control many of the health determinants directly. These determinants include the above
variables and many others, or things that make people healthy or not.

Thus, these determinants can’t be controlled by an individual. It is their interrelations that

helps us to determine which affects their health. Determinants of health reach beyond the
boundaries of traditional health care and public health sectors; sectors such as education,
housing, transportation, agriculture, and environment can be important allies in improving
population health. Addressing the determinants of health is a primary approach to achieving
health equity. Equality is what we need whether you are poor or rich, you should receive the
maximum quality of care. For an instance, just like a disease they don’t pick whether you are
rich or poor so, health equity should be given to all.
TOPIC 3. Philippine Health Agenda for 2016-2022

What we aspire

 Filipinos, especially the poor, marginalized, and vulnerable are protected from high cost
of health care
 Filipinos attain the best possible health outcomes with no disparity
 Filipinos feel respected, valued, and empowered in all of their interaction with the health
system
 Equitable and exclusive to all
 Transparent and accountable
 Uses resources efficiently
 Provides high quality services

During the last 30 years of Health Sector Reform, we have undertaken key structural
reforms and continuously built on programs that take us a step closer to our aspiration.

Milestones
 Devolution
 Uses of Generics
 Milk Code
 PhilHealth
 DOH resources promote local health system development
  Fiscal autonomy for government hospitals
 Good Governance Programs (ISO, IMC, PGS)
 Funding for UHC

GUARANTEE #1 ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE

Services for Both the Well & the Sick (Pregnant, Newborn, Infant, Child Adolescent, Adults,
Elderly)

Elderly First 1000 days, Reproductive and sexual health, maternal, newborn, and child
health, exclusive breastfeeding, food & micronutrient supplementation, Immunization,
Adolescent health, Geriatric Health, Health screening, promotion & information

COMMUNICABLE DISEASES

 HIV/AIDS, TB, Malaria

 Diseases for Elimination
 Dengue, Lepto,
 Ebola, Zika

NONCOMMUNICABLE DISEASES & MALNUTRITION

 Cancer, Diabetes, Heart Disease and their Risk Factors – obesity, smoking, diet,
sedentary lifestyle
 Malnutrition

DISEASES OF RAPID URBANIZATION & INDUSTRIALIZATION

 Injuries
 Substance abuse
 Mental Illness
 Pandemics, Travel Medicine Health consequences of climate change / disaster

GUARANTEE #2 SERVICE DELIVERY NETWORK

Functional Network of Health Facilities

Guarantee 2: Services are delivered by networks that are

 FULLY FUNCTIONAL (Complete Equipment, Medicines, Health Professional),

 ENHANCED BY TELEMEDICINE
 AVAILABLE 24/7 & EVEN DURING DISASTERS
 PRACTICING GATEKEEPING
 COMPLIANT WITH CLINICAL PRACTICE GUIDELINES
 LOCATED CLOSE TO THE PEOPLE (Mobile Clinic or Subsidize Transportation Cost

GUARANTEE #3 UNIVERSAL HEALTH INSURANCE

Financial Freedom when accessing services

Guarantee 3: Services are financed predominantly by PhilHealth

PHILHEALTH AS MAIN REVENUE SOURCE FOR PUBLIC HEALTH CARE PROVIDERS

 Expand benefits to cover comprehensive range of services

 Contracting networks of providers within SDNs

SIMPLIFY PHILHEALTH RULES

 No balance billing for the poor/basic accommodation & Fixed co-payment for non-basic
accommodation
PHILHEALTH AS THE GATEWAY TO FREE AFFORDABLE CARE

 100% of Filipinos are members

 Formal sector premium paid through payroll
 Non-formal sector premium paid through tax subsidy

STRATEGY

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

Advance quality, health promotion and primary care

 Conduct annual health visits for all poor families and special populations (NHTS, IP,
PWD, Senior Citizens)
 Develop an explicit list of primary care entitlements that will become the basis for
licensing and contracting arrangements
 Transform select DOH hospitals into mega-hospitals with capabilities for multi-specialty
training and teaching and reference laboratory
 Support LGUs in advancing pro-health resolutions or ordinances (e.g. city-wide smoke-
free or speed limit ordinances)
 Establish expert bodies for health promotion and surveillance and response

Cover all Filipinos against health-related financial risk

 Raise more revenues for health, e.g. impose healthpromoting taxes, increase NHIP
premium rates, improve premium collection efficiency.

 Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with PhilHealth

 Expand PhilHealth benefits to cover outpatient diagnostics, medicines, blood and blood
products aided by health technology assessment

 Update costing of current PhilHealth case rates to ensure that it covers full cost of care
and link payment to service quality
  Enhance and enforce PhilHealth contracting policies for better viability and sustainability

Harness the power of strategic HRH development

 Revise health professions curriculum to be more primary care-oriented and responsive to

local and global needs
 Streamline HRH compensation package to incentivize service in high-risk or GIDA areas
 Update frontline staffing complement standards from profession-based to competency-
based
 Make available fully-funded scholarships for HRH hailing from GIDA areas or IP groups
 Formulate mechanisms for mandatory return of service schemes for all heath graduates

Invest in eHealth and data for decision-making

 Mandate the use of electronic medical records in all health facilities

 Make online submission of clinical, drug dispensing, administrative and financial records
a prerequisite for registration, licensing and contracting
 Commission nationwide surveys, streamline information systems, and support efforts to
improve local civil registration and vital statistics
 Automate major business processes and invest in warehousing and business intelligence
tools
 Facilitate ease of access of researchers to available data

Enforce standards, accountability and transparency

 Publish health information that can trigger better performance and accountability
 2. Set up dedicated performance monitoring unit to track performance or progress of
reforms

Value all clients and patients, especially the poor, marginalized, and vulnerable
  Prioritize the poorest 20 million Filipinos in all health programs and support them in non-
direct health expenditures
 Make all health entitlements simple, explicit and widely published to facilitate
understanding, & generate demand
 Set up participation and redress mechanisms
 Reduce turnaround time and improve transparency of processes at all DOH health
facilities
 Eliminate queuing, guarantee decent accommodation and clean restrooms in all
government hospitals

Elicit multi-sectoral and multi-stakeholder support for health

 Harness and align the private sector in planning supply side investments
 Work with other national government agencies to address social determinants of health
 Make health impact assessment and public health management plan a prerequisite for
initiating large-scale, high-risk infrastructure projects
 Collaborate with CSOs and other stakeholders on budget development, monitoring and
evaluation

References:

Social Determinants of Health | Healthy People 2020. (2020). Healthypeople.Gov.

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

‌Determinants of Health | Healthy People 2020. (2020). Healthypeople.Gov.

https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-

Health

‌Naik, Y., Baker, P., Walker, I., Tillmann, T., Bash, K., Quantz, D., Hillier-Brown, F., &

Bambra, C. (2017). The macro-economic determinants of health and health inequalities—

 umbrella review protocol. Systematic Reviews, 6(1). https://doi.org/10.1186/s13643-017-

0616-2

‌World Health Organization: WHO. (2020, July 30). Attacks on health care in the context of

COVID-19. Who.Int; World Health Organization: WHO. https://www.who.int/news-

room/feature-stories/detail/attacks-on-health-care-in-the-context-of-covid-19

‌Cutler, D. (2020). How Will COVID-19 Affect the Health Care Economy? JAMA Health

Forum, 1(4), e200419. https://doi.org/10.1001/jamahealthforum.2020.0419

‌COVID-19 and the health sector. (2020, June 26). Ilo.org.

https://www.ilo.org/sector/Resources/publications/WCMS_741655/lang--en/index.htm

‌Polio outbreak in the Philippines. (2018). Who.Int.

https://www.who.int/westernpacific/emergencies/polio-outbreak-in-the-philippines

‌Polio Case Confirmed in the Philippines: DOH to mount mass immunization campaign |

Department of Health website. (2019). Doh.Gov.Ph. https://www.doh.gov.ph/node/18012

‌Polio Outbreak in the Philippines: Should You Be Scared? (2019, November 4). Makati Medical

Center. https://www.makatimed.net.ph/news-and-exhibits/news/polio-outbreak-in-the-

philippines-should-you-be-scared

‌Frequently Asked Questions. (2020). https://www.cdc.gov/nchhstp/socialdeterminants/faq.html

‌Kickbusch, I. (2015). The political determinants of health--10 years on. BMJ, 350(jan08 2), h81–

h81. https://doi.org/10.1136/bmj.h81

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economy-health-care.html