MODULE 2

Module Title: The Health Care Delivery System

Overview:
The Health Care Delivery System defined as the totality of all policies, infrastructures, facilities,
equipment, products, human resources, and services which address the health needs, problems, and
concerns of the people. This influences the status and functions of the Public Health Nurse and need to relate
with the dynamics of the political and organizational structure.

Module Objectives:
At the end of this module, the student should be able to:
1. Describe the Philippine HealthCare Delivery System
2. Discuss the structure, functions activities and programs of the Department of Health
3. Discuss the factors affecting the health care system

Module Coverage
A. Topic: World Health Organization
B. Topic: Philippine Department of Health
C. Topic: Primary Health Care
D. Topic: Levels of Prevention
E. Topic: Universal Health Care (UHC)

TOPIC A:
Topic Title: World Health Organization
Introduction:
Works worldwide to promote health, keep the world safe, and serve the vulnerable. Goal is to ensure that a
billion more people have universal health coverage, to protect a billion more people from health emergencies,
and provide a further billion people with better health and well-being.

Topic Objectives:
At the end of the topic, the student should be able to:
1. Differentiate MDG and SDG
2. Discuss sustainable development goals.
3. Understand the function of WHO

Topic Contents:

For health emergencies, WHO:

1. Prepare for emergencies by identifying, mitigating and managing risks
2. Prevent emergencies and support development of tools necessary during outbreaks
 3. Detect and respond to acute health emergencies
4. Support delivery of essential health services in fragile settings.

For health and well-being:

1. Address social determinants
2. Promote intersectoral approaches for health
3. Prioritize health in all policies and healthy settings.

MILLENNIUM DEVELOPMENT GOALS

1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development

Except for goals 2 and 3, all the MDGs are health or health related. Health is essential to the achievement of
these goals and is a major contributor to the overarching goal of poverty reduction.

SUSTAINABLE DEVELOPMENT GOALS

The Sustainable Development Goals (SDGs), otherwise known as the Global Goals, are a universal call to
action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity.

The SDGs came into effect in January 2016, and they will continue to guide UNDP policy and funding until
2030. As the lead UN development agency, UNDP is uniquely placed to help implement the Goals through
our work in some 170 countries and territories.
 1. DOH, (2008). Public Health Nursing in the Philippines. Philippines
2. https://www.iwh.on.ca/what-researchers-mean-by/primary-secondary-and-tertiary-prevention
3. https://www.slideshare.net/faboritoz/philippine-health-agenda-2016-2022
4. https://nurseslabs.com/levels-of-health-care-referral-system/

TOPIC B
Topic Title: Philippine Department of Health
Introduction:
In order for the public health nurse to fully appreciate the public health system in this country, it is
important to have an understanding of the development of the government agent mandated to protect the
health of the people.

Topic Objectives:
At the end of the topic, the student should be able to:
1. Understand the roles and functions of the DOH
2. Discuss the classification of Health Facilities and Philippine Health Agenda
3. Understand the Philippine Health Care System.

Topic Contents:
PHILIPPINE DEPARTMENT OF HEALTH

VISION BY 2030 (DREAM OF DOH)

A Global Leader for attaining better health outcomes, competitive and responsive health
care systems, and equitable health financing.

MISSION
To guarantee EQUITABLE, SUSTAINABLE and QUALITY health for all Filipinos, especially
the poor and to lead the quest for excellence in health

Principles to attain the vision of DOH

  Equity: equal health services for all-no discrimination.

Quality: DOH is after the quality of service not the quantity
Philosophy of DOH: “Quality is above quantity”
Accessibility: DOH utilize strategies for delivery of health services

ROLES AND FUNCTIONS

1. Leadership in Health
• Provide leadership in the formulation, mentoring and evaluation of national health policies, plans,
and programs
• Advocate
• National Policy and Regulatory Institution
2. Administrator of specific Services
• Manage selected health facilities and hospitals
• Administer direct services for emergent health concerns
• Provide emergency health response services
3. Capacity Builder and Enabler
• Ensure the highest achievable standards of quality health care, promotion, and health protection.
• Innovate new strategies
• Initiate public discussion on health issues
• Oversee implementation, monitoring, and evaluation of national health plans, programs, and
policies

THREE STRATEGIES IN DELIVERING HEALTH SERVICES

1. Creation of Restructured Health Care Delivery System (RHCDS) regulated by PD 568 (1976)
2. Management Information Systems regulated by R.A. 3753: Vital Health Statistics Law
3. Primary Health Care (PHC) regulated by LOI 949 (1984): Legalization of Implementation of PHC
in the Philippines

CREATION OF RHCDS
RHO (National Health Agency) or existing national agencies like PGH or specialized agencies like Heart
Center for Asia, NKI
MHO & PHO (Municipal/Provincial Health Office)
BHS & RHU (Barangay Health Station/Rural Health Unit)

Referral System in Levels of the Health Care

Barangay Health Station (BHS) is under the management of Rural Health Midwife (RHM)
Rural Health Unit (RHU) is under the management or supervision of PHN
Public Health Nurse (PHN) caters to 1:10,000 population, acts as managers in the
implementation of the policies and activities of RHU, directly under the supervision of MHO
(who acts as administrator)

REFERRAL SYSTEM
BHS→ RHU→ MHO→ PHO→ RHO→ National Agencies→ Specialized Agencies

Levels of Health Care System

Definition
There are 3 different levels of health care system which are primary, secondary, and tertiary. In this post,
you’ll get to know more about these health care systems. These referral systems are interlinked or
interconnected to one another.

Primary Level of Care

• Devolved to cities and municipalities
• Usually the first contact between the community members and other levels of health facility.
 • Center physicians, public health nurse, rural health midwives, brgy. Health workers, traditional
healers.
Secondary Level of Care
• Given by physicians with basic health training.
• Usually given in health facilities either private owned or government operated.
• Infirmaries, municipal, district hospital, out-patient departments.
• Rendered by specialists in health facilities.
Tertiary Level of Care
• Referral system for the secondary care facilities.
• Provided complicated cases and intensive care.
• Medical centers, regional and provincial hospitals and specialized hospita

Classification of Health Facilities (DOH AO-00124)

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:
1. Araceli S. Maglaya, (2004). Nursing Practice in the Community (4th ed). Philippines
2. Monina H. Gesmundo, RN RM MAN, (2010). The Basics of Community Health Nursing; A
study Guide for Nursing Students and Local Board Examinees. Philippines
3. https://hfsrb.doh.gov.ph/wp-content/uploads/2019/07/ao2012-0012-1.pdf

TOPIC C
Topic Title: Primary Health Care
Introduction:

Topic Contents:
PRIMARY HEALTH CARE (PHC)

Definitions
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.
Health Education
Treatment of Locally Endemic Diseases
Expanded Program on Immunization
Maternal and Child Health
Provision of Essential Drugs
Nutrition
Treatment of communicable and non-communicable diseases
Safe water and good waste disposal

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 is outlined below:

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

Goal of Primary Health Care

HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the
year 2020.

An improved state of health and quality of life for all people attained through SELF RELIANCE.

The ultimate goal of primary health care is better health for all. WHO has identified five key elements to
achieving that goal:
Reducing exclusion and social disparities in health (universal coverage reforms);
Organizing health services around people’s needs and expectations (service delivery reforms);
Integrating health into all sectors (public policy reforms);
Pursuing collaborative models of policy dialogue (leadership reforms); and
Increasing stakeholder participation.

Key Strategy to Achieve the Goal:

Partnership with and Empowerment 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.

Objectives of Primary Health Care

Improvement in the level of health care of the community
Favorable population growth structure
Reduction in the prevalence of preventable, communicable and other disease.
Reduction in morbidity and mortality rates especially among infants and children.
Extension of essential health services with priority given to the underserved sectors.
Improvement in Basic Sanitation
Development of the capability of the community aimed at self- reliance.
Maximizing the contribution of the other sectors for the social and economic development of the community.

Mission
To strengthen the health care system by increasing opportunities and supporting the conditions wherein
people will manage their own health care.

Two Levels of Primary Health Care Workers

Barangay Health Workers – trained community health workers or health auxiliary volunteers or traditional
birth attendants or healers.
Intermediate level health workers- include the Public Health Nurse, Rural Sanitary Inspector and midwives.

Principles of Primary Health Care

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.

2. Community Participation
Community participation is the heart and soul of primary health care.

3. People are the center, object and subject of development.

Thus, the success of any undertaking that aims at serving the people is dependent on people’s participation
at all levels of decision-making; planning, implementing, monitoring and evaluating. Any undertaking must
also be based on the people’s needs and problems (PCF, 1990)
Part of the people’s participation is the partnership between the community and the agencies found in the
community, social mobilization and decentralization.
In general, health work should start from where the people are and building on what they have. Example:
Scheduling of Barangay Health Workers in the health center
Barriers of Community Involvement
Lack of motivation
Attitude
Resistance to change
Dependence on the part of community people
Lack of managerial skills

4. Self-reliance
Through community participation and cohesiveness of people’s organization they can generate support for
health care through social mobilization, networking and mobilization of local resources.
Leadership and management skills should be develop among these people.
Existence of sustained health care facilities managed by the people is some of the major indicators that the
community is leading to self reliance.

5. Partnership between the community and the health agencies in the provision of quality of life.
Providing linkages between the government and the non-government organization and people’s organization.

6. Recognition of interrelationship between the health and development

Health is defined as not merely the absence of disease. Neither is it only a state of physical and mental well-
being. Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic
factors as its determinant. Good Health therefore, is manifested by the progressive improvements in the living
conditions and quality of life enjoyed by the community residents
Development is the quest for an improved quality of life for all. Development is multidimensional. It has
political, social, cultural, institutional and environmental dimensions (Gonzales 1994). Therefore, it is
measured by the ability of people to satisfy their basic needs.

7. Social Mobilization
It enhances people’s participation or governance, support system provided by the government, networking
and developing secondary leaders.

8. Decentralization
This ensures empowerment and that empowerment can only be facilitated if the administrative structure
provides local level political structures with more substantive responsibilities for development initiators. This
also facilities proper allocation of budgetary resources.

Elements of Primary Health Care

1. Education for Health
2. Locally Endemic Disease Control
3. Expanded Program on Immunization
4. Maternal and Child Health and Family Planning
5. Environmental Sanitation and Promotion of Safe Water Supply
6. Nutrition and Promotion of Adequate Food Supply
7. Treatment of Communicable Diseases and Common Illness
8. Supply of Essential Drugs

Major Strategies of Primary Health Care

1. Elevating Health to a Comprehensive and Sustained National Effort.
Attaining health for all Filipinos will require expanding participation in health and health-related programs
whether as service provider or beneficiary. Empowerment to parents, families and communities to make
decisions of their health is the desired outcome.
Advocacy must be directed to national and local policy making to elicit support and commitment to major
health concerns through legislations, budgetary and logistical considerations.

2. Promoting and Supporting Community Managed Health Care

The health in the hands of the people brings the government closest to the people. It necessitates a process
of capacity building of communities and organization to plan, implement and evaluate health programs at
their levels.

3. Increasing Efficiencies in the Health Sector

Using appropriate technology will make services and resources required for their delivery, effective,
affordable, accessible and culturally acceptable.
The development of human resources must correspond to the actual needs of the nation and the policies it
upholds such as PHC.
The Department of Health (DOH) continue to support and assist both public and private institutions
particularly in faculty development, enhancement of relevant curricula and development of standard teaching
materials.

4. Advancing Essential National Health Research

Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research
using intersectoral, multi-disciplinary and scientific approach to health programming and delivery.

Four Cornerstones/Pillars in Primary Health Care

Active Community Participation
Intra and Inter-sectoral Linkages
Use of Appropriate Technology
Support mechanism made available

TRAINING OF HEALTH WORKERS

3 Levels of Training
Grassroot/Village
Includes Barangay Health Volunteers (BHV) and Barangay Health Workers (BHW)
Non-professionals, did not 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

TOPIC D
Topic Title: Levels of Prevention
Introduction:
Prevention includes a wide range of activities known as “interventions”, aimed at reducing risks or threats to
health.

Topic Objectives:
At the end of the topic, the student should be able to:
1. Understand the levels of prevention
2. Discuss the different examples of levels of prevention

Topic Contents:

LEVEL OF PREVENTION
Primary prevention
 aims to prevent disease or injury before it ever occurs.
 This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy
or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or
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 individuals against these risk factors

Examples include:
• Safe and healthy practices (e.g. use of seatbelts and bike helmets)
• Education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)
• Immunization against infectious diseases.
• Food supplementation and malaria chemoprophylaxis
Secondary prevention
 aims to reduce the impact of a disease or injury that has already occurred.
 This is done by detecting and treating disease or injury as soon as 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 and symptomatic stage of a
disease.
 Aims to diagnose and treat existing health problems at the earliest possible time and to limit
disabilities attributed to it.

Examples include:
• 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.

Tertiary prevention
 aims to soften the impact of an ongoing illness or injury that has lasting effects.
 This is done by helping people manage long-term, often-complex 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
 Deals with the reduction of the magnitude and severity of the residual effects of communicable
and non-communicable diseases.
Examples include:
• Cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for
diabetes, arthritis, depression, etc.)
• support groups that allow members to share strategies for living well
• Control of spread of measles during an epidemic.
TOPIC E
Topic Title: Universal Health Care (UHC)
Introduction:

Topic Objectives:
At the end of the topic, the student should be able to:
1. Understand the Universal Health Care RA 11223

Topic Contents:

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).

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

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://sdgs.un.org/goals
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