University of Saint Anthony

(Dr. Santiago G. Ortega Memorial)

Iriga City
Health Care Education Department

Philippine
Health Care
Delivery System
Submitted to:

Kenny Nińo Tagum

Submitted by:

Randell Euan L. Idioma

 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

Discuss how the world health organization’s affects the health issues in the
Philippines.

The World Health Organization (WHO) declared coronavirus

disease 2019 (COVID-19) to be a Public Health Emergency of
International Concern on January 30 and a pandemic on March
11, 2020. COVID-19 predominantly presents with respiratory
symptoms (cough, sneezing, and sore throat), along with fever,
fatigue and myalgia. It is thought to spread through droplets,
contaminated surfaces, and asymptomatic individuals. By the end
of April, over 3 million people have been infected globally.

The first country to identify the novel virus as the cause of the
pandemic was China. The authorities responded with
unprecedented restrictions on movement. The response included
stopping public transport before Chinese New Year, an annual
event that sees workers' mass emigration to their hometowns,
and a lockdown of whole cities and regions. Two new hospitals
specifically designed for COVID-19 patients were rapidly built in
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

Wuhan. Such measures help slow the transmission of COVID-19

in China.

As of May 2, there are 83,959 confirmed cases and 4,637 deaths

from the virus in China. The Philippines was also affected early by
the current crisis. The first case was suspected on January 22,
and the country reported the first death from COVID-19 outside
of mainland China. Similar to China, the Philippines implemented
lockdowns in Manila. Other measures included the closure of
schools and allowing arrests for non-compliance with measures.
At the beginning of May, the Philippines recorded 8,772 cases and
579 deaths.

China was one of the more severely affected countries in Asia in the early stage of
pandemic while the Philippines is still experiencing an upward trend in the COVID-19
cases. The gross national income (GNI) per capita of the Philippines and China are USD
3,830 and 9,460, respectively, were classified with lower (LMIC) and upper-middle-
income countries (UMIC) by the World bank.

During the COVID-19 pandemic, five high-income countries (HIC), including the United
States, Italy, the United Kingdom, Spain, and France, account for 70% of global deaths.
The HIC faced the following challenges: the lack of personal protection equipment
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

(PPE) for healthcare workers; the delay in response strategy; an overstretched

healthcare system with the shortage of hospital beds, and a large number of death
cases from nursing homes.

The COVID-19 crisis threatens to hit lower and middle-income countries due to
lockdown excessively and economic recession. A systematic review on mental health in
LMIC in Asia and Africa found that LMIC: do not have enough mental health
professionals; the negative economic impact led to an exacerbation of mental issues;
there was a scarcity of COVID-19 related mental health research in Asian LMIC. This
systematic review could not compare participants from different middle-income
countries because each study used different questionnaires. During the previous severe
acute respiratory syndrome (SARS) epidemic, the promotion of protective personal
health practices to reduce transmission of the SARS virus was found to reduce the
anxiety levels in the community.

Before COVID-19, previous studies found that stress might be a modifiable risk factor
for depression in LMICs and UMICs. Another study involving thirty countries found that
unmodifiable risk factors for depression included female gender, and depression
became more common in 2004 to 2014 compared to previous periods. Further, there
were cultural.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

Describe the Philippine Health Care Delivery System as to its components

and sectors.

Health Care Delivery in the Philippines

The Philippine Health Care Delivery. Health care system is an organized plan of health
services. The rendering of health care services to the people is called health care
delivery system. Thus, health care delivery system is the network of health facilities and
personnel which carries out the task of rendering health care to the people. In the
Philippines health care system is complex set of organizations interacting to provide an
array of health services.

In the Philippines the components of the health care delivery system as mandate of the
Department of Health (DOH) is to be responsible for the following: formulation and
development of national health policies, guidelines, standards and manual of operations
for health services and programs; issuance of rules and regulations, licenses and
accreditations; promulgation of national health standards, goals, priorities and
indicators; development of special health programs and projects and advocacy for
legislation on health policies and programs.

The primary function of the Department of Health is the promotion, protection,

preservation or restoration of the health of the people through the provision and
delivery of health services and through the regulation and encouragement of providers
of health goods and services.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

The DOH vision is "Health as a right. Health for All Filipinos by the
year 2000 and Health in the Hands of the People by the year
2020." While its mission is "DOH, in partnership with the people
to ensure equity, quality and access to health care by: making
services available; arousing community awareness; mobilizing
resources; and promoting the means to better health. 

In the Philippine healthcare setting health care facilities are level

as Level I, Level II, and Level III. Level I (Primary Level of Health
Care Facility) are the rural health units, their sub-centers, chest
clinics, malaria eradication units, and schistosomiasis control units
are directly operated by the DOH; puericulture centers operated
by League of Puericulture Centers; tuberculosis clinics and
hospitals of the Philippine Tuberculosis Society; private clinics,
clinics operated by the Philippine Medical Association; clinics
operated by large industrial firms for their employees; community
hospitals and health centers operated by the Philippine Medicare
Care Commission and other health facilities operated by voluntary
religious and civic groups.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

Differentiate the referral system from the inter-local health zone.

INTER LOCAL HEALTH ZONE

An ILHZ is defined to be any form or organized arrangement for coordinating the

operations of an array and hierarchy of health providers and facilities, which typically
includes primary health providers, core referral hospital and end-referral hospital, jointly
serving a common population within a local geographic area under the jurisdictions of
more than one local government.

ILHZ, as a form of inter-LGU cooperation is established in order to better protect the

public or collective health of their community, assure the constituents access to a range
of services necessary to meet health care needs of individuals, and to manage their
limited resources for health more efficiently and equitably.

For these to happen, existing ILHZs in the country must strengthen their operations and
sustain their functionality. Regardless of the organizational nature of each ILHZ,
whether these are formally organized, informally organized or DOH-initiated, the overall
aim is to make each ILHZ functional in order to perform its abovementioned purposes
and tasks.

REFERRAL SYSTEM

Referral is a dynamic process, in which a health worker at one level of the health
system, having insufficient resources (drugs, equipment, skills) to manage a clinical
condition, seeks the help of a better or differently resourced facility at the same or
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

higher level to assist in. Health care systems of every country are designed in such a
way to encourage patients to first attempt to get care at the primary level and then to
approach a higher level of care according to the need. This protocol minimizes the costs
for the caretaker/patients. However, in most of the countries, patients often bypass
primary care facilities and directly go to the higher center thereby, increasing the
burden on higher level facilities, the picture is not very different in India also. Health
care system in India is plugged by: overpopulation, lack of expert clinicians, skewed
distribution of physicians, lack of motivation among existing health care personnel and
an ineffective referral mechanism.

Due to failure of conventional paper-based referral systems in our country, we can

introduce an e-referral system in the era of internet. It is evident from our experiences,
that this artificial intelligence enabled e-referral system has many advantages over the
traditional paper-based referral system. It will aid health workers for timely
management of cases. Most importantly, it will streamline the existing unorganized
referral process. Although, for effective e-Referral system, there should be a
collaborative platform where easy search and discovery for health care providers is
possible and help in decision making. e- Referral should be incorporated in our health
system to strengthen it by bridging the access gap may be through Public Private
Partnership model.

Distinguish the levels of healthcare, service and facilities.

The Types Of Healthcare Practices

 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

Each health issue requires a certain level of healthcare depending on the individual and
the intensity of the health issue he faces. Based on the level of care a patient requires
the healthcare practices have been divided into three major categories.

Primary Healthcare:
 As the name implies it refers to the primary care focuses on the basic healthcare
services that address the health issues faced by an individual.
 The care does not require a specialist and can be addressed comprehensively by
a general physician.
 Primary care is witnessing a vigorous growth in both the developed and
developing cities across all countries in the world.
 The goal is to make the general health solutions accessible to every individual as
per the guidance of WHO.
 Primary care expects the increased participation of the general healthcare
players, induce good healthcare practices at the basic level and meeting the
expectations of the healthcare receivers.

Secondary Healthcare:
 Secondary Healthcare includes specialists such as cardiologists, dermatologists,
urologists and other specialists.
 Individuals reach out to the secondary medical care providers through the
referral of the primary healthcare professionals.
 In few countries, the individuals cannot consult the specialists without the
referral of the medical practitioner at the primary care level.
 The secondary healthcare providers act as a liaison between the patient and the
advanced medical care.

Tertiary Healthcare:
 This is the care comes into the picture as a referral to patients by the primary
and healthcare providers.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

 The individuals may require advanced medical procedures such as major

surgeries, transplants, replacements and long-term medical care management
for diseases such as cancer, neurological disorders.
 The specialized consultive medical care is the highest forms of healthcare
practices and performs all the major medical procedures.
 Advanced diagnostic centers, specialized intensive care units and modern
medical facilities are the key features in the Tertiary Medical Care.
 The practices that provide tertiary medical care could be part of the government
or a combination of both public and private sectors. The healthcare system in
India is an example of the latter.
The healthcare providers who are part of these three levels of healthcare order,
together provide medical services such as health issue finding, evaluating, providing
treatment or referring to the next level of care based on the health needs.
The ever-increasing demand for health needs is pushing the borders of healthcare,
forcing it to tread the new paths. And, managing a sector with such huge potential
could be driven in the success path with the help of healthcare consulting firms in India.

Discuss the the HEALTH SECTOR REFORM.

Health sector reform deals with fundamental change processes in policies and
institutional arrangements, usually guided by the government. A radical change is
impossible without realistic and robust political leadership and sound scientific evidence.
Experience of many countries suggests that the success of reforms lies in how the
process is applied and by whom, rather than how the contents are formulated.
Sustained information and education on health sector reform are needed to generate
wider political and public understanding and support. Continuous monitoring and review
of health systems development are required. Research support is required to provide
valid scientific evidence for strengthening the processes and mechanisms of health
sector reform.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

Whether developed, developing or least developed countries, an increasing number of

them has introduced health sector reforms. Recent experiences in both developed and
developing countries have shown that health sector reforms are highly political and
fiercely contested processes. The reforms are more complex especially in developing
countries due to the presence of a wide range of contracting partners, including donor
agencies. In most cases, the call for health sector reform is voiced more from outside of
the countries than from within. And, the economic pressure on the governments,
specifically on account of the health sector, has forced them to initiate a series of
reforms within and beyond the health sector. The overall aim of all these reforms is to
improve equity, efficiency and quality of health care. Most reform measures are meant
to ensure that an appropriate share of public funds (overall government expenditure) is
spent on health care, or there is an equitable distribution of public health expenditure
across all levels of health care, or there

is an appropriate mix of public and private spending in health development (i.e.

alloceNve efficiency)? The users have to be satisfied with both the form and content of
health services offered (i.e. improved health status and client satisfaction); and the
benefits of publicly funded health care (including preventive health interventions) are
also equitably distributed (i.e. improved equity of access to care).
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

Enumerate the various reform initiatives that shaped Philippine

Health Care Delivery System

Health Facilities Health facilities in the Philippines include government hospitals, private
hospitals and primary health care facilities. Hospitals are classified based on ownership
as public or private hospitals. In the Philippines, around 40 percent of hospitals are
public (Department of Health, 2009). Out of 721 public hospitals, 70 are managed by
the DOH while the remaining hospitals are managed by LGUs and other national
government agencies (Department of Health, 2009). Both public and private hospitals
can also be classified by the service capability (see DOH AO 2005-0029). A new
classification and licensing system will soon be adopted to respond to the capacity gaps
of existing health facilities in all levels. At present, Level-1 hospitals account for almost
56 percent of the total number of hospitals (Department of Health, 2009; Lavado,
2010) which have very limited capacity, comparable only to infirmaries.

The Department of Health (DOH) celebrates the signing of the Universal Health Care
(UHC) Act into law and congratulates all Filipinos for this accomplishment. DOH
acknowledges the consistent support from legislators and different stakeholders from
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

civil society organizations, local government units, other national government agencies,
and international partners in pushing for the UHC Act.

“Health is everybody’s business. Health systems only work when everyone works
together to ensure that no one is left behind,” says Secretary Francisco T. Duque III.

UHC is both a vision and a commitment to the health of all Filipinos by providing the full
range of high quality health care services – from preventive to promotive, curative,
rehabilitative, and palliative – at affordable cost. The signing of the UHC Act is a
remarkable achievement as it marks the beginning of a new chapter in the reform of
the Philippine health system. These include operationalizing primary health care and
mainstreaming health promotion to protect people from disease, empowering
individuals and communities to maintain good health, and supporting effective
management of illness and disability. It will shift the health system’s current treatment-
oriented approach towards a more balanced approach emphasizing prevention and
health promotion.

Among the significant reforms that will be implemented over time include: automatic
enrollment of all Filipinos to PhilHealth; designating PhilHealth as the national purchaser
for health goods and services for individuals, such as medicines; improvement of health
facilities especially in underserved areas; responding to the gap in health workers
throughout the country; strategic engagement of the private sector; and creating and
expanding new functions in DOH to improve the delivery of health services.

“We thank the commitment of our Senators and Congresspersons to legislating for the
people’s health, and the President’s fulfillment of his promise to improve the healthcare
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

system of the country for the benefit of all Filipinos. Let us harness this
momentum, walang iwanan at sama-sama tayo tungo sa UHC!” Secretary Duque
added. The period for drafting the law’s implementing rules and regulations
immediately follows its signing with public consultations and multi-sectoral dialogues
scheduled in the coming months.

Explain the salient features of the Universal Health Care Law in

the Philippines.

What is Universal Health Coverage (UHC)?

Universal Health Coverage means that all people can benefit from quality health
services, where and when they need them, without suffering financial hardship. It has 3
key dimensions:

1. Access to health services: everyone who needs services should get them, not
only those who can pay for them.
2. Financial risk protection: people should not fall into debt paying for treatment
and care. 
3. Quality of services:  services should be adequate and effective.
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
Iriga City
Health Care Education Department

Why is UHC important?

At least half of the world's population still lack full coverage with essential health
services.

 At least half of the world’s population (7.3 billion people) still do not have
access to the full range of essential health services.
 Over 800 million people (almost 12% of the world's population) use at least 10%
of their household budgets for out-of-pocket health expenditures. 
 Almost 180 million people spend a quarter or more of their household budgets
on health.
 This population is increasing at a rate of almost 5% per year, with women
among those worst affected (WHO/World Bank 2017).
 In a number of countries, the cost of cancer treatment and care, including
cancer drugs, has pushed many cancer patients and their families to near
bankruptcy.
 A study from India, for example, found that the odds of incurring catastrophic
hospitalisation expenditures were nearly 160% higher for a patient with cancer
than the odds of incurring catastrophic spending when hospitalisation was due to
a communicable condition (WHO 2011).