THE HEALTH CARE DELIVERY SYSTEM

THE TOTALITY OF ALL POLICIES, FACILITIES, 2. Zero hunger

EQUIPMENT, PRODUCTS, HUMAN RESOURCES, 3. Good health and well-being
AND SERVICES THAT ADDRESS THE HEALTH 4. Quality education
NEEDS PROBLEMS, AND CONCERNS OF THE 5. Gender equality
PEOPLE. IT IS LARGE, COMPLEX, MULTI-LEVEL, 6. Clean water and sanitation
AND MULTI-DISCIPLINARY. 7. Affordable and clean energy
8. Decent work and economic growth
Health Sectors 9. Industry, innovation, infrastructure
● Government Sectors 10. Reduced inequality
● Non Government Sectors 11. Sustainable cities and communities
● Private Sectors 12. Responsible production and consumption
13. Climate action
Factors that influence the health care 14. Life below water
delivery system: 15. Life on land
● Health care reforms 16. Peace and justice strong institutions
● Demographics 17. Partnerships to achieve the goal
● Globalization
● Poverty and growing disparities B. Philippine Department of Health
● Social Disintegration
Vision:( To be the leader of health for all in the
Global and Country Health Trend Philippines)Filipinos are among the healthiest people
❑ Shifts in demographic and epidemiological in Southeast Asia by 2022, and Asia by 2040.
trends in diseases.
Mission:( Guarantee equitable, sustainable, and
❑ New technologies of health care,
quality health for all Filipinos, especially the poor, and
communication, and information.
to lead the quest for excellence in health.) To lead the
❑ Existing and emerging environmental
country in the development of a productive, resilient,
hazard
equitable, and people-centered health system
❑ Health reforms
DOH Core Values
❑

A. World Health Organization

1. Millennium Developmental Goal ( MDG )
Target – Reduce global poverty and hunger
2. Sustainable Development Goals (SDG )
A collection of 17 global goals designed to be a
"blueprint to achieve a better and more sustainable
future for all". The SDGs, set in 2015 by the United
Nations General Assembly and intended to be
achieved by the year 2030.
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. Global partnership for development
1. No poverty
1. Integrity
2. Excellence
3. Compassion and respect for human dignity
4. Commitment
5. Professionalism
6. Teamwork
7. Stewardship of the health of the people.
Historical Background:
▣ In 1944, President Manuel Roxas signed
Executive Order (E.O.) No. 94 into law,
calling for the creation of the Department of
Health.
▣ On February 20, 1958, Executive Order
288 provided for the reorganization of the
Department of Health.
▣ With a shift to a parliamentary form of
government, the Department of Health was
transformed into the Ministry of Health on
June 2, 1978.
▣ On April 13, 1987, the Department of
Health was created by the previous Ministry
of Health.
▣ In 1987, the re-organization under
Executive Order No. 119, which placed
under the Secretary of Health five offices
headed by an undersecretary and an
assistant secretary.
◼ These offices are:
🢭 Chief of Staff, Public Health
Services, Hospital and Facilities
Services, Standard Regulations
and Management Service
 ▣ In 1992, the full implementation of Republic
Act No. 7160 or Local Government Code.
The DOH changed its role from one of
implementation to one of governance.
▣ In 1999, the functions and operations of the
DOH was directed to become consistent
with the provisions of Administrative Code
1987 and RA 7160 through Executive
Order 102

Local Health Systems:

Refers to all organizations, institutions, and
resources devoted to undertaking health
actions to improve the health status of a
population. (WHO)
▣ Health Financing
◼ National and local government
◼ Insurance
◼ User fees/out of pocket
◼ Donors
▣ Health Care Delivery System
◼ Health facilities
◼ Health human resource
◼ Utilization of health facilities
◼ Satisfaction with health facilities
▣ Governance and Regulation
◼ Enactment of LGC in 1991
◼ PhilHealth
◼ Insurance Commission
◼ Health Sector Reform Agenda in
1999
◼ FOURmula One for Health in 2005
◼ Universal Health Care in 2011
Devolution of Services
▣ Devolution
◼ Act by which the national government
confers power and authority upon the
various LGUs to perform specific
functions and responsibilities
▣ In 1992, the Philippine Government
devolved the management and delivery of
health services from the National
Department of Health to locally elected
provincial, city and municipal governments.
▣ RA 7160 (Local Government Code of
1991 ) to "provide for a more responsive
and accountable local government
structure instituted through a system of
decentralization

Classification of Health Facilities (

DOH AO-0012A )

Philippine Health Agenda


C. Primary Health Care
Overview
● 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
the community level.
The rationale for Adopting Primary Health Care
● MagnitudeThe magnitude of Health Problems
● Inadequate and unequal distribution of health
resources
● IncreasingThe increasing cost of medical care
● Isolation of health care activities from other
development activities
Definition of Primary Health Care
● Essential health care is 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 can afford at every stage
of development.
Goal:
● HEALTH FOR ALL FILIPINOS by the year
2000 AND
PHC Theme:
● 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.
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
● The favorable population growth structure
● Reduction in the prevalence of preventable,
communicable, and other diseases.
● 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.
● Elements of Primary Health Care
1. Education for Health
Is one of the potent methodologies for information
dissemination. It promotes the partnership of both
the family members and health workers in the
promotion of health as well as prevention of illness.
2. Locally Endemic Disease Control
The control of endemic disease focuses on the
prevention of its occurrence to reduce the
morbidity rate. Example Malaria Control and
Schistosomiasis Control
3. Expanded Program on Immunization
This program exists to control the occurrence of
preventable illnesses especially of children below
6 years old. Immunizations on poliomyelitis,
measles, tetanus, diphtheria and other
preventable disease are given for free by the
government and ongoing program of the DOH
4. Maternal and Child Health and Family Planning
The mother and child are the most delicate
members of the community. So the protection of
the mother and child to illness and other risks
would ensure good health for the community. The
goal of Family Planning includes spacing of
 children and responsible parenthood.
5. Environmental Sanitation and Promotion of
Safe Water Supply
Environmental Sanitation is defined as the study
of all factors in the man’s environment, which
exercise or may exercise deleterious effect on his
well-being and survival. Water is a basic need for
life and one factor in man’s environment. Water is
necessary for the maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic
promotion of health.
6. Nutrition and Promotion of Adequate Food
Supply
One basic need of the family is food. And if food is
properly prepared then one may be assured
healthy family. There are many food resources
found in the communities but because of faulty
preparation and lack of knowledge regarding
proper food planning, Malnutrition is one of the
problems that we have in the country.
7. Treatment of Communicable Diseases and
Common Illness
The diseases spread through direct contact pose
a great risk to those who can be infected.
Tuberculosis is one of the communicable
diseases continuously occupies the top ten
causes of death. Most communicable diseases
are also preventable. The Government focuses on
the prevention, control and treatment of these
illnesses.
8. Supply of Essential Drugs
● This focuses on the information campaign on
the utilization and acquisition of drugs.
● In response to this campaign, the GENERIC
ACT of the Philippines is enacted. It includes
the following drugs: Cotrimoxazole,
Paracetamol, Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH (isoniazid) and Pyrazinamide,
Ethambutol, Streptomycin,
Albendazole,Quinine
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
heart and soul of PHC
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 organizations, they
can generate support for health care through
social mobilization, networking, and
mobilization of local resources. Leadership and
management skills should be developed
among these people. The existence of
sustained health care facilities managed by the
people is one 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 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 (PCF,
● 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 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.
Major Strategies of Primary Health Care
1. Elevating Health to a Comprehensive and
Sustained National Effort.
2. Promoting and Supporting Community Managed
Health Care
3. Increasing Efficiencies in the Health Sector
4. Advancing Essential National Health Research
Four Cornerstones/Pillars in Primary
Health Care
● Active Community Participation
● Intra and Inter-sectoral Linkages
● Use of Appropriate Technology
● Support mechanism made available
Two Levels of Primary Health Care
Workers
1. Barangay Health Workers – trained community
health workers or health auxiliary
volunteers or traditional birth attendants or
healers.
2. Intermediate level health workers - include the
Public Health Nurse, Rural Sanitary
Inspector and midwives.
Traits and Qualities of a Health Worker
1. Efficient
● plans with the people, organizes, conducts,
directs health education activities according
to the needs of the community
● knowledgeable about everything relevant to
his practice; has the necessary skills
expected of him
2.Good listener
● hears what’s being said and what’s behind
the words
● always available for the participant to voice
out their sentiments and needs
3. Keen observer
● keep an eye on the proceedings, process
and participants’ behavior
4. Systematic
● knows how to put in sequence or logical
order the parts of the session
5. Creative/Resourceful
● uses available resources
6. Analytical/Critical thinker
● decides on what has been analyzed
7. Tactful
● brings about issues in smooth subtle manner
● does not embarrass but gives constructive
criticisms
8. Knowledgeable
● able to impart relevant, updated and
sufficient input
9. Open
● invites ideas, suggestions, criticisms
● involves people in decision making
● accepts the need for joint planning and
decision relative to health care in a particular
situation; not resistant to change
10. Sense of humor
● knows how to place a touch of humor to keep
audience alive
11. Change agent
● involves participants actively in assuming the
responsibility for their own learning
12. Coordinator
● brings into consonance of harmony the
community’s health care activities
13. Objective
● unbiased and fair in decision making
14. Flexible
● able to cope with different situations
Functions of a Health Worker
1. Community Health Service Provider
● Carries out health services contributing to the
promotion of health, prevention of illness,
early treatment of illness and rehabilitation.
● appraises health needs and hazards
(existing or potential)
2. Facilitator
● helps plan a comprehensive health program
with the people
● continuing guidance and supervisory
assistance
● functions of a Health Worker.
3. Health Counselor
● provides health counseling including
emotional support to individuals, family,
group and community
4. Co-researcher
● Provides the community with stimulation
necessary for a wider or more complex study
or problems.
● Enforce community to do prompt and
intelligent reporting of epidemiologic
investigation of disease.
● suggest areas hat need research (by
creating dissatisfaction)
● participate in planning for the study in
formulating procedures
● Assist in the collection of data
● Helps interpret findings collectively
● Act on the result of the research
5. Member of a Team
● in operating within the team, one must be
willing to listen as well as to contribute, to
teach as well as to learn, to lead as well as to
follow, to share as well as to work under it
● helps make multiple services which the
family receives in the course of health care,
coordinated, continuous and comprehensive
as possible
● consults with and refers to appropriate
personnel for any other community services
6. Health Educator
● Health education is an accepted activity at all
levels of public works. A health educator is
the one who improves the health of the
people by employing various methods of
scientific procedures to stimulate, arouse and
guide people to healthful ways of living. She
takes into consideration these aspects of
health education:
● information – provision of knowledge
● education – change in knowledge, attitude
and skills
● communication – exchange of information
D. Levels of Prevention
 Levels of Prevention seeks to improve, streamline, and scale up
the reform strategies in HSRA and Fl in order
to address inequities in health outcomes by
Primary (heath Secondary Tertiary ensuring that all Filipinos, especially those
promotion and (early diagnosis (limitation of belonging to the lowest two income quintiles,
specific and treatment) disability and have equitable access to quality health care.
protection) rehabilitation)
UHC's Objective
•Dietary teaching •HIV testing •Teaching new ● to ensure that every Filipino shall receive
during •Screening for clients with affordable and quality health benefits.This
pregnancy cervical CA diabetes how to involves providing adequate resources –
•Immunizations •Dental administer insulin health human resources, health facilities, and
•Education or examinations •Exercise therapy health financing.
counseling •Diabetes after stroke UHC’s Three Thrusts
regarding screening for •Skin care for 1. Financial risk protection through expansion in
smoking, dental family at risk incontinent enrollment and benefit delivery of the
care or nutrition •Vision screening patients National Health Insurance Program (NHIP)
•Adequate of first-grade •Mental health 2. Improved access to quality hospitals and
housing school counseling or health care facilities
•Mother’s class •Mass sputum referral for family 3. Attainment of health-related Millennium
on breastfeeding examination in a in crisis Development Goals (MDGs).
•Education for low-income •Dietary
drug abuse neighborhood instructions and Milestone in Health Care Delivery
prevention for •Hearing tests at monitoring for System
high school a center for the family with ● RA 1082 – RHU Act
students elderly overweight There shall be created rural health units of
members two classes: one of category one or senior
rural health unit consisting of one municipal
health officer as head of the unit, one public
health nurse, one mid-wife and one sanitary
•Primary (heath Secondary Tertiary (limitation inspector; another of category two or junior
promotion (early of disability and rural health unit consisting of one physician
ancommunities diagnosis rehabilitation) or public health nurse as head of the unit and
•VDRL scred and one midwife or sanitary inspector. Each
specific treatment) municipality or group of municipal districts
protection) having a population of not less than five
thousand shall have a rural health unit of
•Flouride water •Organized •Group counseling category one: Provided, however, that a
supplementation screening for grade school municipality with more than thirty-five
•Environmental programs for children with asthma thousand inhabitants shall have an additional
sanitation ening for •Exercise program rural health unit of category two. If the public
•Removal of marriage for diabetics at a service so demands, the Director of Health,
environmental license center for the elderly upon approval of the Secretary of the
hazards applicants in a •Alcoholics Department of Health, can regroup
city Anonymous and neighboring barrios and assign to each group
other self-help a rural health unit of whatever category the
groups circumstances warrant.cralaw
•Mental health
services for military ● RA 1891 – Strengthen Health Services
veterans ❖ An Act strengthening health and dental
services in the rural areas, and providing
funds therefor".
E. Universal Health Care ❖ There shall be created rural health units of
eight different categories or staff of personnel
Legal Basis: RA 11223 corresponding to eight population groups of
● an Act instituting Universal Health Care for municipalities to be served based on a more
all Filipinos, prescribing reforms in the health equitable and scientific distribution on the
care system, and appropriating funds ratio of personnel to population:
therefor. ● Category I, consisting of one midwife and
● Universal Health Care Act one sanitary inspector, to be allotted to a
● automatically enrolls all Filipino citizens in municipality of Group I with a population up
the National Health Insurance Program and to
prescribes complementary reforms in the ● Category II, consisting of one public health
health system. nurse and one midwife or one sanitary
inspector, to be allotted to a municipality of
UHC's Background and Rationale Group II with population from two thousand
● Universal Health Care is an approach that to five thousandtwo thousand.
● Category III, consisting of one municipal
health officer, as head of the unit, one public
health nurse, one midwife and one sanitary
inspector, to be allotted to a municipality of
Group III with population from five thousand
to ten thousand.
● Category IV, consisting of one municipal
health officer, as head of the unit, one public
health nurse, two midwives and one sanitary
inspector, to be allotted to a municipality of
Group IV with population from ten thousand
to twenty thousand.
● Category V, consisting of one municipal
health officer, a head of the unit, two public
health nurses, two midwives and one
sanitary inspector, to be allotted to a
municipality of Group V with population from
twenty thousand to thirty thousand.
● Category VI, consisting of two municipal
health officers, two public health nurses, two
midwives and two sanitary inspectors, to be
allotted to a municipality of Group VI with
population from thirty thousand to forty
thousand
● Category VII, consisting of two municipal
health officers, two public health nurses,
three midwives and three sanitary inspectors,
to be allotted to a municipality of Group VII
with population from forty thousand to fifty
thousand;
● Category VIII, consisting of two municipal
health officers, four public health nurses, four
midwives and three sanitary inspectors, to be
allotted to a municipality of Group VIII with
population from fifty thousand and over.

● PD 568 – Restructuring HCDS

● Role of Public Health midwives has been
expanded after the
● implementation of the Restructed Health
Care Delivery System (RHCDS)

● Deployment of midwives to
improve rural situation
(1 PHMid = 5,000 pop.; 1 PHNurse = 10,000
pop; 1 RHPhysician = 20,000 pop)

● RA 7160 – LGU Code

otherwise known as the Local Government
Code was enacted into law, transferring
control and responsibility of delivering basic
services to the hands of local government
units (LGU). It aimed to enhance provision
of services in the grass roots level as well
as improve the efficiency in resource
allocation.