Submitted by:

Jay-Anne Rapano
Rachelle Ann Maestre

1. Identify one current global health issue and write a discussion or reaction about the issue.
The Plight of Primary Health Care
Early this year, the World Health Organization (WHO) released a list of urgent, global health
challenges that must be promptly addressed in order to lessen or prevent their threat to public
health. Among the list are (1) Elevating health in the climate debate; (2) Delivering health in
conflict and crisis; (3) making healthcare fairer; (4) Expanding access to medicine; (5) Stopping
infectious disease; (6) Preparing for epidemics; (7) Protecting people from dangerous products;
(8) Investing in the people who defend health; (9) Keeping adolescent safe; and (10) earning
public trust.
These challenges arise because of inadequate investment of resources in core health
priorities and systems. While countries invest heavily in warfare and economic advancement,
they fail to recognize the significant impact of health to the economic and social aspects of a
nation. The present COVID-19 pandemic has brough the nations on their bended knees and has
exposed the weakness of public health, which is on Primary Health Care. Primary health care
has long been neglected of resource allocation and attention specially in the underdeveloped
and developing countries where delivery of basic health services in the primary, secondary and
tertiary level of prevention is still a great challenge, hence, health problems such as the
emergence of infectious and communicable diseases, maternal and child health, malnutrition
and etc., are still major health threats that affect a significant number of population.
Amidst the COVID-19 Pandemic and the emergence of these challenges, the capacity of
primary health care to deliver fundamental health needs and attain the objectives of the
Universal Health Coverage (UHC) is a major concern. The Universal Health Coverage (UHC) was
identified as one of the major targets among nations of the world when the Sustainable
Development Goals was adopted in 2015. UHC means that all individuals and communities
receive the health services they need without suffering financial hardship. It includes the full
spectrum of essential, quality health services, from health promotion to prevention, treatment,
rehabilitation, and palliative care. UHC enables everyone to access the services that address the
most significant causes of disease and death and ensures that the quality of those services is
good enough to improve the health of the people who receive them.

Primary health care is the most efficient and cost-effective way to achieve universal health
coverage around the world. Primary health care is an approach to health and wellbeing
centered on the needs and circumstances of individuals, families and communities.  It
addresses comprehensive and interrelated physical, mental, and social health and wellbeing. It
is about providing whole-person care for health needs throughout life, not just treating a set of
specific diseases. Primary health care ensures people receive comprehensive care, ranging from
promotion and prevention to treatment, rehabilitation, and palliative care as close as feasible
to people’s everyday environment.
 Among the emerging problems of Primary Health Care implementation identified in the
Global Review of Primary Health Care conducted by the World Health organization are (1) A
lack of political commitment and leadership, and insufficient policy continuity as a result; (2)
Initial objectives were unrealistic, and are not being achieved; (3) Local PHC services are seen as
inappropriate, and are bypassed by the communities they serve; (4) There is a lack of
integration between PHC and other parts of the health (and social care) system; (5) PHC staff
have the wrong skills, and are not motivated; (6) An effective intersectoral approach has not
been developed; (7) PHC policies and models are not sustainable; and (8) Community
Involvement is not working.
In another study conducted by Dodd, et all (2019), they asserted that the following
strategies must be undertaken to resolve the challenges of PHC implementation: (1) NPHW
workforce development; (2) integrating non-communicable disease prevention and control into
the basic package of care; (3) building managerial capacity; (4) institutionalizing community
engagement; (5) modernizing PHC information systems.
In our point of view, the present time calls for stronger and more efficient
implementation of the PHC. Health care resources for Health promotion and prevention,
screening and diagnostics, and treatment and rehabilitation must be made available and
accessible specially by vulnerable populations. Rural Health Units must also be capacitated and
empowered to reach out to all communities and realize the objectives of universal health care.
It is our contention that the biggest loophole in the implementation of Public Health
Care lies on poor governance and inadequate policy formation. Changing health issues and
demographic diversity demand for a dynamic and relevant policies in health care, it must be
responsive and adequate to meet the demands of the people across ages and nations. PHC has
long been neglected, and has not received adequate funding, hence, the vulnerability of
communities to health threats such as maternal and child morbidity and mortality, infectious
diseases and mental health issues continue to plague them.
The implementation of PHC in rural areas and in the grassroots of the health care
ecosystem must done to determine areas where funding and allocation of resources could be
done. Policies for capacity building among health care institutions must be made to ensure that
they can promote health care and address health concerns of their respective populations.
2. Identify a current health problem here in the Philippines and answer the following:
Challenges amidst Institutionalization of Disaster Risk Reduction and Management for Health
Philippines ranked third among all the countries with the highest risks for disaster
worldwide according to the World Risk Report 2018, with index value of 25.14% (World
Economic Forum, 2018). At least 60% of the country’s total land area is exposed to multiple
hazards, and 74% of the population is susceptible to their impact (GFDRR, 2017). This is largely
due to the location and geographical context as the risk involving coastal hazards such as
typhoons, storm surges and rising sea levels is high. Also, as the islands are located within the
“Ring of Fire” between the Eurasian and Pacific tectonic plates, earthquakes and volcanoes are
posing serious risks to the safety of the populace. Flooding, landslides, droughts and tsunamis
further contribute to the exposure to natural hazards. Of these, hydro-meteorological events
including typhoons and floods, accounted for over 80% of the natural disasters in the country
during the last half-century (Jha, 2018).
The most recent catastrophe that the country has endured was super typhoon Lawin
(Haiyan) in 2016, considered the strongest and most destructive typhoon that hit the region in
decades left 12,715 families affected; 208,551 totally damaged houses; P5.29 billion worth of
damage in agriculture; and 8 people dead. A year after the devastating typhoon, the provinces
specially Cagayan and Isabella, has yet to fully recover, as some families are still homeless, and
physical infrastructures were not yet reconstructed. The people may overcome their loss of
homes and properties, but for some, they will forever grieve the loss of their love ones,
families, and friends.
At present, the country is still battling the wrath of COVID-19 Pandemic which has
already caused global disaster. This catastrophe has revealed a lot of health and social concerns
such as the capacity of health workforce and public facilities.
The National Disaster Risk Reduction and Management Plan, the country’s framework
for disaster risk reduction and management delegated the functions of the health care delivery
system spearheaded by the Department of Health as (1)Health Services; (2) Nutrition; (3)
Water, Sanitation and Hygiene (WASH); and (4) Mental Health and Psychosocial Support
Services. (NDRRMP, 2014). The implementation of these roles and functions are critical
especially in disaster prone regions and municipalities, and in far-flung underserved
communities given that one of the biggest challenges of the health care delivery system up to
these days is inadequate facilities. In Region II, there are only four regional hospitals and
thirteen district hospitals to cater for five provinces, and these facilities are located in cities and
in major municipalities that are not easily accessible to other communities, especially those
located in coastal and mountainous areas. This situation is not only observed in the region but
in the whole country as well. Recognizing the challenges of resource mobilization, the Disaster
Risk Reduction and Management for Health (DRRM-H) envision a goal of building disaster
resilient communities through community participation, and capacity building of Rural Health
Units in the implementation of the health services in the four phases of disaster management
namely Disaster Risk Reduction and Mitigation, Disaster Preparedness, Disaster Response and
Disaster Recovery and Rehabilitation.
Rural Health Units are the frontlines in providing health care services and implementing
the health care programs and reforms of the Department of Health. It is a health facility that
provides basic clinical, preventive, promotive, curative, and rehabilitative services for the
municipality/city. (R.A. No. 1082) In recent years, the functionality of Rural Health Units were
challenged by social, political and geographical factors as their financial resources largely
depend on Local Government Units, hence the inequity of health services being delivered by a
high class municipality compared to middle class and low class municipalities. The
institutionalization of DRMM-H faces the same predicament as recent evaluation from the
Department of Health revealed inadequate allocation of resources of LGUs to their RHUs,
hence, programs to capacitate the health workers and provide facilities for medical services,
Water Sanitation and Hygiene (WASH), Nutrition in emergency, and Mental Health and
Psychosocial Services (MHPSS) are not properly implemented and often times neglected.
In the past years, Philippines together with other developing countries has endured the
tremendous impact of disasters in their economy, as development has been haltered and
billions worth of resources were damaged, the country also mourned the death of its people.
This has brought realization to that long term goal and strategies must be employed in order to
lessen the risk and vulnerability of the people and the country to disasters and their impacts,
and create communities capable of responding to disasters, or disaster-resilient communities.
Despite the effort, it has been observed that agencies which play vital roles in Disaster Risk
Reduction and Management, especially in rural communities such as the Rural Health Units
have not been given attention for capacity building.
Public Health Facilities are vital in the attainment of disaster-resilient communities,
hence the need to evaluate their capability of providing communities with essential public
health services during disaster risk management, and build capacity for sustainability,
Maldonado et al (2012)asserted that public health facilities must perform in accordance with
standards set, and recommended the use of a specific assessment approach to evaluate their
performance, which will serve as basis for building partnership and capacity for long term goals
and sustainability.

A. What country has the same problem as the Philippines?

Just like the Philippines, India has been vulnerable to natural disasters on account of its
unique geo-climatic conditions. Floods, droughts, cyclones, earthquakes, and landslides have
been recurrent phenomena. About 60% of the landmass is prone to earthquakes of various
intensities, over 40 million hectares is prone to floods, about 8% of the total area is prone to
cyclones, and 68% of the area is susceptible to drought. India has been struck by numerous
disasters in the recent past including, among the major ones, the Bangalore circus tragedy
(1981), Bhopal gas tragedy (1984), Gujarat cyclone (1998), Orissa super cyclone (1999), Gujarat
earthquake (2001), annual flooding in large parts of the country during the monsoon, and the
tsunami in 2004. The response to disasters has gradually improved over the years, as lessons
have been learnt from each disaster and adapted.
India has not been spared by COVID-19 pandemic either, it is one of the countries in
Asia that has recorded the highest number of cases, and at point has even on top of countries
with highest number of cases. This has reflected the weakness in the implementation of the
Disaster management of the country despite the government’s initiatives in the recent years to
create resilient system to respond to emergency and disaster situations.
In 2010, Srivastava, K, enumerated the following factors which inhibits India’s response
to disasters in the past which include, lack of a national-level plan policy, absence of an
institutional framework at the center / state / district level, poor intersectoral coordination, lack
of an early warning system, slow response from the relief agencies, lack of trained / dedicated
search and rescue teams, and poor community empowerment.
Nineteen (19) years after, in a study conducted by Singh, Madhav in 2019, he concluded
that India is still struggling to fully implement its Disaster Management System in heathcare due
to underdeveloped triage skills, poor emergency coordination between hospitals, lack of
portable diagnostic equipment and, the lack of specific disaster plans, surge capacity, and
psychological interventions. Other challenges are the fragmentation of the emergency health
service system, a lack of specific legislation for emergencies, disparities in the distribution of
funding, and inadequate cost-effective considerations for disaster rescue.
The struggle of the institutionalization of DRMM-H in the Philippines can also be
attributed to these factors. It is also noteworthy that the framework for disaster management
of both countries are similar and patterned to the recommendations set by the WHO and
UNICEF.
B. Compare the strategies between the countries to alleviate the issue.
Just like the Philippines, the Disaster management of India is also divided into phases of
Prevention and Mitigation, Preparedness, Response and Rehabilitation. Furthermore, it also
involves multisectoral approach such that the system is under the mandate of the National
Government with direct supervision from the Local Government Units, but, health, economic
and social sectors are also involve in the implementation of the programs.
Funding of the programs of the Disaster Management in India just like in the Philippines
come from the fund of the national as well as the local government, hence, the same problems
arise in terms of equity and equality of resources, because the communities with greater IRA
are expected to have better funding compared to the underprivilege communities.
C. Identify the Key Roles of various agencies about the issue.
Disaster Management for Health is a multisectoral approach. The national Government
through the Department of Health is the primary agency responsible for its planning,
implementation and supervision and evaluation. A specific office under the DOH was created
purposely for the institutionalization of DRMM-H. It is responsible for building capacity among
health care facilities specially the Rural health Units and Barangay Health Stations in terms of
implementation of the four core areas of DRMM-H which are Medical Services, WASH,
Nutrition in emergency and Mental Health and Psychosocial Support.
The Department of Interior and Local Government is also vital in the implementation of
the program because it has the mandate over the local government units to allocate funds and
capacitate their RHUs in responding to disasters.
Department of Social Work and Development (DSWD) plays great role in providing
support to the RHUs in terms of social services and mental health promotion through debriefing
and counseling.
The National Nutrition Council and Department of Agriculture are agencies that should
be greatly involve in the DRMM-H in terms of nutrition amidst emergency and disaster
situations. Ensuring food sustainability and nutritional status of the population affected.
Aside from these are other agencies and organizations that need to be involved in the
institutionalization of DRMM-H such as the Department of Science and Technology,
Department of Environmental and Natural Resources, Red Cross etc. However, the agenda and
programs of each agencies in terms of DRMM must be harmonized to ensure their relevance
and effectiveness. Furthermore, coordination is necessary to carry out a multisectoral approach
in DRMM-H.
3. Identify a current research that pertains to global health issue and answer the following:

A. Explain the global health initiative and purpose for global health.
PFIZER AND BIONTECH, two of the world’s biggest pharmaceutical companies are currently
undertaking a research experiment on COVID-19 vaccine, the BNT162 mRNA vaccine program,
and modRNA candidate BNT162b2 (including qualitative assessments of available data,
potential benefits, expectations for clinical trials, anticipated timing of regulatory submissions
and anticipated manufacturing, distribution and supply), that involves substantial risks and
uncertainties that could cause actual results to differ materially from those expressed or
implied by such statements.
As of November 18, the companies announced that, after conducting the final efficacy
analysis in their ongoing Phase 3 study, their mRNA-based COVID-19 vaccine candidate,
BNT162b2, met all of the study’s primary efficacy endpoints. Analysis of the data indicates a
vaccine efficacy rate of 95% (p<0.0001) in participants without prior SARS-CoV-2 infection (first
primary objective) and also in participants with and without prior SARS-CoV-2 infection (second
primary objective), in each case measured from 7 days after the second dose. The first primary
objective analysis is based on 170 cases of COVID-19, as specified in the study protocol, of
which 162 cases of COVID-19 were observed in the placebo group versus 8 cases in the
BNT162b2 group. Efficacy was consistent across age, gender, race and ethnicity demographics.
The observed efficacy in adults over 65 years of age was over 94%.
The Phase 3 clinical trial of BNT162b2 began on July 27 and has enrolled 43,661 participants
to date, 41,135 of whom have received a second dose of the vaccine candidate as of November
13, 2020. Approximately 42% of global participants and 30% of U.S. participants have racially
and ethnically diverse backgrounds, and 41% of global and 45% of U.S. participants are 56-85
years of age. A breakdown of the diversity of clinical trial participants can be found here from
approximately 150 clinical trials sites in United States, Germany, Turkey, South Africa, Brazil and
Argentina. The trial will continue to collect efficacy and safety data in participants for an
additional two years.
B. What can it contribute to society?
This research experimentation aims to discover a vaccine that will be used against Corona
Virus 19 that has recently caused a worldwide pandemic. Considering that viral infections have
no specific drugs of choice, and most of the anti-viral drugs are expensive, and were not proven
effective against this particular strain of virus, vaccine is the most practical and efficient solution
considered to halt the continuous transmission of the viral infection.
As nation’s around the world awaits for the antidote against this pandemic, this initiative
gives a glimmer of hope that in the coming year it will be made available for administration
across population.
C. What nations can benefit from this research and why?
The product from this research endeavor, which is COVID-19 Vaccine will benefit all
countries around the world as it will give immunity to people who will be receiving the vaccine
from getting infected.
In Asia alone, where almost all countries have recorded cases of Covid-19 infection, and
some just like the Philippines are still battling continuous rise in cases will be greatly benefitted
because as cases continuously rise, healthcare resources in these countries specially in
developing countries may no longer be enough to meet the demands of health, considering
that the economy was also greatly affected, the government is in dire need of a solution to
continue economic initiatives that were hindered by the global pandemic.
4. What strategies can we benchmark from other countries like USA, Switzerland, ASEAN
region and United Kingdom, etc. to help our own country in improving our health care
system?
Through the years, the Philippine Government’s aspirations to improve the health
outcomes of its people, provide them protection from the impoverishing effects of the
increasing cost of care and ensure that the health system is responsive to the population’s
health needs were embodied in several iterations of its health reform policies.
However, strong political support and wider fiscal space do not automatically translate to
improvements in the health system, as there is a lack of institutional capacity to translate policy
into effective program implementation, monitoring and evaluation. National-level directives
and huge financial resources need to be translated to the operations and delivery of critical
programs. For instance, while PhilHealth’s membership coverage has expanded and its payment
mechanism has improved, strategic purchasing has yet to ensure access to comprehensive and
quality health services by its members. Meanwhile, despite the DOH’s investments to construct
and upgrade local health facilities and deploy critical health staff, access remains highly
inequitable due to the maldistribution of facilities, health personnel and specialists. This either
reflects that the investment is too small to make a change or there are efficiency challenges.
With the increased financial resources for health, overlapping areas occur in financing and
delivering health services, while critical health needs such as addressing the increasing burden
of NCDs, including mental and oral health, and remain inadequately funded.
In terms of mobilization of health care resources in the community, the country can adopt
various strategies by the members of the ASEAN, example, in Cambodia, The Health Equity
Fund is a type of social transfer mechanism that provide subsidies for the poor, and can be
implemented by international or local NGOs, using funding that may be provided by donors,
Government or community collections (Thomé & Pholsena, 2009). In Malaysia, the strategy
is in terms of empowering the individual, family and community in program such
community based health promotion with local community as one of the stakeholder and also
integrated school health promotion like ‘Tunas Doktor Muda’ at pre-school and ‘IMFREE’
program at primary school level (Ministry of Health Malaysia, 2016). In Singapore, they
empowering the community with health services delivered by the community volunteers at the
community facilities with collaboration with ministry of health holding, Singapore, Singapore
Business Federation and local networking (Introduction to Singapore Healthcare, 2016). In
Timor-Leste, they reconstructing the health facilities, expanding community based health
services such as the integrated community health services and a considerable number of
national medical graduates have joined the health workforce, and are serving at district and
administrative post levels (The National Strategic Development Plan 2011–2030 in Timor-Leste)
 The United Kingdom, being a first world country has not been spared of the challenges in its
health care delivery system, however, through the England National Health Services, it has
implemented these measures to augment the demands of health care.
1. Increasing the Supply of Health Professionals.
Physician supply is being boosted by a 55 percent increase in medical school intake, pay
incentives, flexible return-to-work schemes for doctors with young children, and international
recruitment. 7 Similar approaches have expanded NHS nurse numbers by more than 50,000
since 1997.
2. Modernizing Infrastructure.
Public hospitals are being rebuilt on “private finance initiative” contracts in which the
private sector designs, builds, finances, and operates them. Over the next three years £2.3
billion is being spent so that electronic health records covering all fifty million people in England
are rolled out alongside electronic prescribing and scheduling. The aim is to improve quality of
care (for example, by reducing medication errors and lost medical records and providing online
decision support); improve patients’ experiences (by reducing delays and giving patients a
choice of providers and certainty of appointment scheduling); and boost efficiency (by better
use of staff time, reduced duplication of tests, and active case management).
3. Supported Learning and Improvement.
The main NHS mechanism for building on health professionals’ desire to improve services is
the NHS Modernization Agency, which is responsible for horizontal spread of reengineering and
service redesign techniques at a cost of £220 million a year. 9 Programs include cancer, cardiac,
and primary care and elective surgery, and they draw on the optimistic insight that someone
somewhere is probably already delivering the high performance desired for the system as a
whole. It is complemented by the NHS’s own corporate university, NHSU, which will provide
lifelong learning opportunities for health staff, and a National Patient Safety Agency, which runs
a national reporting system for adverse events.
5. Design a Global health initiative that may help the people in your workplace, home, or
eventually other countries.
Capacitating the Rural Health Units towards Universal and Sustainable Health Care Delivery
System

Multisectoral Department of Health

Approach

(DILG, NGO’s
Private
Organizatons

Regular and
Comprehensive
assessment of
community health
status and needs.

Rural
Health
Units
Provision of Adequate Empowerment of
medical Equipment and Health Care
Services Professionals

Accessible health
Fair compensation
care facility
Professional
Adequate Drugs and
development through
medical Equipment
trainings and seminars

Community People

Accessible and Equitable Health

Services

Apart from inadequate health care resources, one of the major problems faced by the
Philippine Health care system is on the equitable distribution of these resources to ensure that
the poorest and underserved communities received the greatest health services. This problem
is largely attributed to the incapacity of the Rural Health facilities in terms of infrastructures and
equipment which include basic medical supplies and medicines, and insufficient human
resource which include physicians and nurses.
 While devolution has its advantages for an archipelagic country like Philippines, the
weakness lies in on the great dependence of health services among community health facilities
to their Local Government Units. In a present scenario, a low-class municipality with lower
Internal Revenue Allotment (IRA) is expected to have lower budget allocation to its health
sector compared to a first class or a municipality with greater IRA. In effect, people who are
expected to have lower socio-economic status and greater need for health assistance who live
in this low class municipality are receiving lesser.
With this premise, it is high time that the national government provide greater support
through improvement of facilities, employment of well trained health practitioners and
constant monitoring of health programs among these Rural Health Units to ensure that people
in Geographically Isolates and Depressed Areas (GIDA) are given accessible and attainable
health services. Private organizations and NGOs must be encouraged to engage in this capacity
building to assist the government financially.
References:
Aditya Bahadur, Emma Lovell and Florence Pichon. (2016). Strengthening disaster risk
management in India: A review of five state disaster management plans. Retrieved at
India-disaster-management-web.pdf (cdkn.org)
Appiah-Agyekum, N. (2020). Primary healthcare implementation in practice: Evidence from
primary healthcare managers in Ghana. African Journal of Primary Health Care & Family
Medicine, 12(1), 7 pages. doi:https://doi.org/10.4102/phcfm.v12i1.2183
Dodd, Rebecca & Palagyi, Anna & Jan, Stephen & Abdel-All, Marwa & Nambiar, Devaki &
Madhira, Pavitra & Balane, Christine & Tian, Maoyi & Joshi, Rohina & Abimbola, Seye &
Peiris, David. (2019). Organisation of primary health care systems in low- and middle-
income countries: review of evidence on what works and why in the Asia-Pacific region.
BMJ Global Health. 4. e001487. 10.1136/bmjgh-2019-001487..
Ministry of Health Malaysia. (2016). Pelan Strategik KKM 2016-2020. Kementerian
Kesihatan Malaysia, 1-29
Mohamad Saidi, Mohamad Syafiq Sidqi & Adnin, Nur & Lai, Wei Kuang & Manaf, Rosliza & Juni,
Muhamad. (2019). STRATEGIES FOR HEALTH CARE COST CONTAINMENT IN SOUTH-EAST
ASIA COUNTRIES. International Journal of Public Health and Clinical Sciences. 5. 2289-
7577.
World Health Organization. Towards a Strategic Agenda for the WHO Secretariat. Statement by
the Director-General to the Executive Board at its 105th session. January 2000. EB105/2
https://www.who.int/news-room/photo-story/photo-story-detail/urgent-health-
challenges-for-the-next-decade
Srivastava K. (2010). Disaster: Challenges and perspectives. Industrial psychiatry journal, 19(1),
1–4. https://doi.org/10.4103/0972-6748.77623
Singh, Madhav. (2019). HEALTHCARE ADMINISTRATIVE CHALLENGES & SOLUTIONS IN DISASTER
MANAGEMENT IN INDIA. Indian Journal of Scientific Research. 8. 1-3.
Thomé, J.-. M., & Pholsena, S. (2009). Promoting Sustainable Strategies to Improve Access
to Health Care in the Asian and Pacific Region.