CHAP 3: THE PHILIPPINE HEALTHCARE DELIVERY SYSTEM SUSTAINABLE DEVELOPMENT GOALS: • 1915 – Organization of the Social and Home
• 1915 – Organization of the Social and Home Care
THE WORLD HEALTH ORGANIZATION:
- Constitution was established on April 7, 1948
- Headquarters in Geneva, Switzerland
- Has 147 country offices
- Has 6 regional offices (Africa, the Americas, Eastern
Mediterranean, Europe, Southeast Asia, Western Pacific
GLOBAL AND NATIONAL HEALTH SITUATIONS:
The eight MDGs:
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 global partnerships for development
- (Except for goals 2 and 3, all 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.
- Core Functions:
▪ Providing leadership on matters critical to health and
engaging in partnerships where joint action is
needed.
▪ Setting norms and standards and promoting and
monitoring their implementation.
▪ Articulating ethical and evidence-based policy
options.
▪ Providing technical support, catalyzing change, and
building sustainable institutional capacity.
▪ Shaping the research agenda and stimulating the
generation, translation, and disseminating valuable
knowledge.
• *Priorities
• *Organization
• *Standards
• *Capacity
• *Translation
- The Sustainable Development Goals are a set of
17 goals defined by the United Nations launched
in September 2015. It addresses a number of
social and environmental development issues. The
goals are also known as “Transforming our World:
the 2030 Agenda for Sustainable Development.”
PHILIPPINES DEPARTMENT OF HEALTH:
Historical Background:
• Pre-Spanish and Spanish Periods (before 1898)
- Use traditional health care practices; Western
concept of healing were widely practiced
- Establishment of the first medical dispensary for
indigent patients of Manila by Franciscan Friar Juan
Clemente that was began in 1577
• 1690
- Installation of water system in San Juan del Monte
and Manila by Dominican Father Juan de Pergero
• 1805
- Introduction of smallpox vaccination by Dr. Francisco
de Balmis
DOH HISTORICAL BACKGROUND:
• 1876 – appointment of the first Medicos Titulares ,
equivalent to provincial health officers
• 1888 – A Superior Board of Health & Charity was
created by the Spaniards which established a hospital
system & a board of vaccination
- Graduation of the first cirujanos ministrantes from
UST
• 1898, June 23
- Department of Public Works, Education & Hygiene
was created by virtue of a decree signed by
• 1901 – Creation of the Board of Health of the Philippine
Islands by the United States Philippine Commission
through Act 157.
• 1905 – Foundation of La Gota de Leche by Asociacion
Feminista Filipina
• 1912 – Creation of sanitary divisions by the Fajardo Act
Service unit of PGH
• Before WWW II – Establishment of municipal and charity
clinics
• 1947 – Reorganization of DOH into bureaus
• 1954 – Approval of R.A.1082 (Rural Health Act) by the
Congress
• 1957 – Enactment of R. A. 1891 amending certain
provisions in the Rural Health Act
• 1970s – Restructure of the Philippine health care
delivery system classifying health services
• 1954 – Approval of R.A.1082 (Rural Health Act) by the
Congress
• 1991 – enactment of R.A. 7160 (Local Government
Code)
• 1999 – Launched the Health Sector Reform Agenda; Its
implementation framework FOURmula One (F1) in 2005
and Universal Health Care in 2010
• September 2000 – Signed to the United Nations
Millennium Declaration
ROLES AND FUNCTIONS OF DOH:
1. Leadership in Health
- Serve as the national policy and regulatory
institution.
- Provides leadership in the formulation, monitoring
and evaluation of national health policies, plans,
and programs.
- Serve as advocate in the adoption of health
policies, plans and programs to address national
and sectoral concerns.
2. Enabler and Capacity Builder
- Innovate new strategies in health.
- Initiate public discussions on health issues.
- Disseminate policy research outputs.
- Exercise oversight functions and monitoring and
evaluation of national health plans, programs,
and policies.
 - Ensure the highest achievable standards of quality
health care, health promotion and health
protection.
3. Administrator of Specific Services
- Manages selected national health facilities and
hospitals and referral centers.
- Administer direct services for emergent health
concerns that require new complicated
technologies.
- Administer health emergency response services.
VISION OF DOH:
- The DOH is the leader, staunch advocate and model
promoting Health for All in the Philippines.
local/regional) to the local government units to
facilitate health service delivery.
- Devolution made local government executives
responsible to operate local health services;
- New centers of authority for local health services
emerged – provincial, city, municipal governments,
including an autonomous regional government and a
metropolitan authority.
- Provincial governments operate the hospital system -
Provincial and District Hospitals; while city/municipal
governments operate the Health Centers (HC) Rural
Health Units (RHU) and Barangay Health Stations
(BHS). NEW CLASSIFICATION OF OTHER HEALTH

MISSION OF DOH: CLASSIFICATION OF HEALTH FACILITIES (DOH AO- FACILITIES:

- Guarantee equitable, sustainable and quality health for 0012A):
all Filipinos, especially the poor and shall lead the quest
• DOH Administrative Order No. 2012-0012: Rules and
for excellence in health.
regulations governing classification of Hospitals and
CORE VALUES OF DOH:
other Health Facilities in the Philippines (Approved in
1. Integrity
July 18, 2012).
2. Excellence
• Classification of General Hospitals:
3. Compassion and respect for human dignity
4. Commitment
5. Professionalism
6. Teamwork
7. Stewardship of the health of the people INCONSISTENCY OF OLD CLASSIFICATION VS LAW:
• Levels of Health Care Delivery and the Rural Health Unit
1. General Hospital
LOCAL HEALTH SYSTEM:
- Provides services for all kinds of all illnesses, injuries,
• HISTORICAL BACKGROUND
or deformities.
- For over 40 years after post war independence, the
- Services offered are classified as level 1, level 2, or
Philippine health care system was administered by a
level 3.
central agency based in Manila; this provided the
singular sources of resources, policy direction,
technical and administrative supervision to all health
facility nationwide.
- In 1991, major shift took place – Local Government
Code known as Republic Act 7160, under this law, all
- Therefore, Level 1 does not qualify as a hospital and
structures, personnel and budgetary allocations from
must be given a different category for licensure
the provincial health level down to the barangays
purposes.
were devolved (transfer or delegate; from central to
-
CLASSIFICATION OF HOSPITALS:
According to Ownership:
A. Government
- Created by law. May be under DOH, DND, DOJ,
PNP, LGU, SUCs, and others
B. Private
- May be a single proprietorship, partnership,
corporation, cooperative, foundation, religious,
non-government organization and others.
According to Functional Capacity:
A. General Hospital
- Provides medical and surgical care to the sick
and injured and maternity care and shall have as
minimum, the following clinical services: medicine,
pediatrics, obstetrics, emergency services, out-
patient and ancillary services.
B. Private
- Specializes in a particular disease or condition or
in one type of patient.
EXAMPLES OF SPECIALTY HOSPITALS:
CLASSIFICATION OF HOSPITALS:
According to Trauma Capability:
A. DOH licensed hospital designated as a trauma
center.
B. DOH licensed hospital within the trauma service area
which receives trauma patients for transport to the
point of care or a trauma center.
OTHER HEALTH FACILITIES:
1. Primary Care Facility (Category A)
- A first-contact health care facility offers basic
services including emergency services and
provision for normal deliveries
2. Custodial care facility (Category B)
- Provides long-term care, including basic
services, to patients with chronic conditions
requiring ongoing health and nursing care due
to impairment and a reduced degree of
independence in ADLs, and patients in
rehabilitation.
3. Diagnostic/therapeutic facility (Category C)
- For the examination of the human body,
specimens from the human body for the
diagnosis, sometimes treatment of disease, or
water for drinking water analysis.
- Laboratory facility, radiologic facility, nuclear
medicine facility
4. Specialized Outpatient Facility
- Performs highly specialized procedures on an
outpatient basis.
PHILIPPINE HEALTH AGENDA 2010-2012:
PRIMARY HEALTH CARE:
• Primary Health Care or PHC is defined as essential
health care 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 and country can afford at every stage
of development. (WHO)
• PHC refers to essential health care that is based on
scientifically sound and socially acceptable methods
and technology, which make universal health care
accessible to all individuals and families in community.
(Wikipedia)
→ BRIEF HISTORY
- PHC was declared during the First International
Conference on Primary Health Care held in Alma
Ata, USSR on September 6-12, 1978 by WHO.
→ LEGAL BASIS
- Adopted by the Philippines through the Letter of
Instruction (LOI) 949 signed b”y President Ferdinand
E. Marcos on October 1979 with an underlying
theme ,“Health in the Hands of the People by 2020.
→ GOAL “Health for All by the year 2000”
→ DEFINITION
- The concept of PHC is characterized by partnership
and empowerment of the people that shall
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.
- PHC is a strategy which focuses responsibility for
health on the individual, his family and the
community; it includes full participation and active
involvement of the community towards the
development of self-reliant people, capable of
achieving an acceptable level of health and well-
being.
- PHC also recognizes interrelationship between
health and the overall political, socio-cultural and
economic development of society; although the
goal of PHC of Health of Health for All in the Year
2020may have already been challenged as
unrealizable in the given time frame, the concept
and processes has already taken root all over the
world and has shown progress in the lives of peoples
in communities it has empowered.
→ ELEMENTS/COMPONENTS OF PRIMARY HEALTH CARE
1. Environmental Sanitation (adequate supply of safe
water and good waste disposal)
2. Control of Communicable Diseases
3. Immunization
4. Health Education
5. Maternal and Child Health and Family Planning
6. Adequate Food and Proper Nutrition
7. Provision of Medical Care and Emergency
Treatment
 8. Treatment of Locally Endemic Diseases - The framework of meeting the goal of PHC is - At this level, health services workers can work
9. Provision of Essential Drugs organizational strategy, which calls for active and to retain re-educate and rehabilitate people
→ PRINCIPLES AND STRATEGIES: continuing partnership among the com- munities, who have already developed an impairment
1. Reorientation and reorganization of the national private and government agencies in health or disability; targets populations that have
health care system with the establishment of development. experienced disease or injury and focuses on
functional support mechanism in support of the → FOUR CORNERSTONES/PILLARS IN PRIMARY limitation of disability and rehabilitation.
mandate of devolution under the Local HEALTH CARE - aims to reduce the effects of disease and
Government Code of 1991. injury and to restore individuals to their
1. Active community participation
2. Effective preparation and enabling process for optimal level of functioning.
2. Intra and Inter-sectoral linkages
health action at all levels.
3. Use of appropriate technology
3. Mobilization of the people to know their
4. Support mechanism made available.
communities and identifying their basic health
→ LEVELS OF PREVENTION:
needs with the end in view of provi- ding
- Prevention as it relates to health, is about
appropriate solutions (including legal measures)
avoiding disease before it starts. It has been
leading self- measures) leading to self-
defined as the plans for, and the measures taken
determination.
to prevent the onset of a disease or other health
4. Development and utilization of appropriate
problem before the occurrence of the
technology focusing on local indigenous
undesirable health event. The following are the
resources available in and acceptable to the
three distinct levels:
community.
a. Primary Prevention – the preventive measure that UNIVERSAL HEALTH CARE (UHC):
5. Organization of communities arising from their
prevent the onset of illness or injury before the → UNIVERSAL HEALTH CARE (UHC)
expressed needs which they have decided to
disease begins. - is also referred to as Kalusugan Pangkalahatan(KP) , is
address and that this is continually evolving in
- directed at preventing a problem before it the “provision to every Filipino of the highest possible
pursuit of their own development.
occurs by altering susceptibility or reducing quality of health care that is accessible, efficient,
6. Increase opportunities for community
exposure for susceptible individuals. equitably distributed, adequately funded, fairly
participation in local level planning,
General health promotion financed, and appropriately used by an informed
management, monitoring and evaluation within
Specific protection and empowered public.”
the context of regional and national objectives.
b. Secondary Prevention – those preventive → LEGAL BASIS
7. Development of intra-sectoral linkages with other
measures that lead to early diagnosis and prompt - New UHC Act is a critical step towards health for all
government and private agencies so that
treatment of a disease, illness or injury to prevent Filipinos. Fifty years after the Philippines made it policy
programs of the health sector is closely linked with
more severe problems developing. Here health to gradually provide total medical service for its
those of other socio-economic sectors of the
educators such as Health Extension Practitioners people through a medical care act, the President of
national, intermediate and community levels.
can help individuals acquire the skills of detecting the Philippines, Rodrigo R. Duterte, signed into law the
8. Emphasizing partnership so that the health
diseases in their early stages Universal Health Care Act (Republic Act 11223) on
workers and the com- munity leaders/members
- early detection and prompt intervention February 20, 2019 at Malacaňang Palace, Manila.
view each other as partners rather than merely
during the period of early disease → Background and Rationale
providers and receivers of healthcare especially.
pathogenesis - Filipinos will begin benefitting from the Universal
PRIMARY HEALTH CARE:
c. Tertiary prevention – those preventive measures at Health Care (UHC) Act this year, with every citizen
rehabilitation following significant illness.
 entitled to health coverage that will lower out-of-
pocket health expenses.
- The passage of the Republic Act 11223 was hailed a
path-breaking as it set the direction for the reform of
the health care sector in the Philippines.
- WHO earlier urged the Philippine government to
make a “real investment” in health, as it would save
lives.
- Currently, Department of Health (DOH), Philippine
Health Insurance Corporation (PhilHealth) along with
experts and concerned agencies are crafting the
Implementing Rules and Regulations (IRR). They will
have 180 days to complete the IRR, which will include
details on how the law is executed.
- Filipinos can now already expect to avail some of the
law’s benefits as the full effects of the law will be
gradually felt over the years as DOH and PhilHealth
start transitioning to the universal health care system.
- Eight (8) things to know about UHC:
1. All Filipinos are covered.
▪ Every single Filipino citizen is automatically
enrolled into the newly-created National
Health Insurance Program (NHIP); two
classifications of members:
Direct contributors – those who pay PhilHealth
premiums, are employed and are bound by
an “employer-employee relationship”, e self-
earning, professional practitioners, and
migrant workers.
Indirect contributors – those not considered as
direct contributors along with their qualified
dependents whose health premiums are
subsidized by the government
2. It is not completely free.
▪ The law outlines that basic services
accommodations will be covered by
PhilHealth.
3. PhilHealth will become the “national purchaser”
of health goods and services.
▪ PhilHealth will be in charge of paying health
care providers like hospitals and clinics for
services given to Filipinos
▪ Background and Rationale: Allocating more
funds to PhilHealth will also strengthen its
negotiating power with heath care
providers, which will foreseeably improve the
quality of services and lower health costs.
4. DOH will still be in charge of “population-based”
health services.
▪ While PhilHealth, along with other private
health insurance companies, is expected to
cover services for individuals, the DOH is still
in charge of delivering health services that
cover the entire population; DOH will do this
by contracting public health care providers
in cities and provinces.
5. Health systems will become city-wide and
province-wide.
▪ Provinces and highly urbanized cities will
now be in charge of overseeing health
services in areas as opposed to the current
set-up where municipalities and are tasked
with managing their own health centers.
▪ DOH will need to work with the Department
of the Interior Local Government (DILG) to
have province and city-wide health systems
or networks in about two years after the law
takes effect.
6. Return service in public health sector.
▪ Graduates of health and health-related
courses who received government-funded
scholarships will be required to work in the
public at least 3 full years.
7. A “Health Technology and Assessment Council”
(HTAC) will be created.
▪ HTAC is a group of health experts who will
be responsible for evaluating latest health
developments and recommending their use
to DOH and PhilHealth; they will be
responsible for assessing the safety and
effectiveness of health technology, devices,
medicines, vaccines, health procedures and
other healthrelated advances developed to
solve health problems.
8. Health information will be collected.
▪ Both public and private hospitals and health
insurers will be required to maintain a health
information system that will contain
electronic health records, prescription logs,
and “human resource information.”
OBJECTIVES AND THRUST:
• Universal Health Care (UHC) Law Republic Act
11223) automatically enrolls all Filipino citizens in
the National Health Insurance Program and
prescribes complementary reforms in the health
system.
- This gives citizens access to the full continuum of
health services they need, while protecting
them from enduring financial hardships as a
result
POPULATION-FOCUSED APPROACH AND COMMUNITY
HEALTH NURSING INTERVENTIONS:
• Focuses on the entire population
• Is based on assessment of the populations’ health
status
• Considers the broad determinants of health
• Emphasizes all levels of prevention
• Intervenes with communities, systems, individuals
and families
PHILOSOPHY OF COMMUNITY HEALTH NURSING PRACTICE:
• PHILOSOPHY
- Defined as a system of beliefs that provides a
basis for and guides action
- It provides the direction and describes the
whats, whys and hows of activities within the
profession
PHILOSOPHY OF CHN PRACTICE:
 H – humanistic values of the nursing profession upheld - Consults the health center & receives health services in ▪ Believes in a power beyond himself and in
U – unique & distinct component of health care different forms transcending one’s limitations in order to become
M – multiple factors of health considered - Can be seen both as clients and patients a better person
A – active participation of clients encouraged - Can be used as an “entry point” in working with the 4. THINKING OR INTELLECTUAL BEING
N – nurse considers availability of resources whole family ▪ Capable of perception, cognition &
I – interdependence among health team members - Can be seen in two ways/approach: communication
practiced a. Atomistic: Proposed by Byrne and Thompson ▪ Capable of logical thinking and reasoning
S – scientific and up-to-date ▪ Views man as an organism 5. PSYCHOLOGICAL BEING
T – tasks of CH nurse vary with time and place ▪ Sees the whole as equal to the sum of its ▪ capable of feeling, rationality, and all conscious
I – independence or self-reliance is the end goal parts or subparts and unconscious mental states
C – connectedness of health & development regarded ▪ Levels of organization include: 8-12 FAMILY:
BASIC PRINCIPLES OF CHN: 1. chemical level - Defined by Murray and Zentner, 1997, a small social
• The COMMUNITY is the PATIENT in CHN 2. organelle level system and primary reference group made up of two or
- FAMILY is the UNIT OF CARE 3. cellular level more persons living together who are related by blood,
- FOUR LEVELS OF CLIENTELE: 4. tissue level marriage, or adoption or who are living together by
a. individuals 5. organ level arrangement over a period of time
b. families 6. system level POPULATION GROUP OR AGGREGATE:
c. population groups b. holistic - Is a group of people sharing the same characteristics,
d. Community ▪ Traces the pattern of man’s relationship with developmental stage, or common exposure to
• Client is considered an ACTIVE PARTNER other beings in the suprasystem of society particular environmental factors
• Affected by developments in health technology in ▪ How man acts and reacts to situational - Example:
particular and changes in society in general stimuli provide clues in understanding his 1. children
• The goal is achieved through MULTISECTORAL EFFORTS responses and the reasons behind them - Most vulnerable to different types of diseases,
• CHN is part of HEALTH CARE SYSTEM and the larger ▪ Man as a whole is different from and is more especially those brought about by socio-
HUMAN SERVICES SYSTEM then the sum of his component parts economic difficulties
▪ Dimensions include: physical, social, spiritual, - Predominantly afflicted with infectious diseases
cognitive and psychological and nutrition problems
FIVE DIMENSIONS OF MAN: 2. women
1. PHYSICAL BEING 3. farmers
▪ Genetic endowment 4. cultural minorities
▪ Sex 5. elderly
▪ Physical attributes - Individuals belonging to the age group of 60
2. SOCIAL BEING years and above
▪ Capable of relating to others - With the lengthening of the lifespan of the
▪ Process of social learning by which a person Filipinos, it is best that health professionals
acquires KSA and roles appropriate to sex, social understand the health needs of the elderly
class, and ethnic or cultural group FAMILY: FUNCTION
3. SPIRITUAL BEING - Primary function of the family is to ensure the
• Individual as a Client:
▪ capable of virtues such as faith, hope and charity continuation of society, both biologically through
- Deals with sick or well
 procreation and socially through socialization; for far away from home, will retain a feeling of caring, experience that they can trust their parents. Lack of
parents closeness and belonging. trust at home becomes the most destructive weapon
- Basic functions of the family are: 2. A healthy family has meaningful social and religious and sickness within the family.
1. regulate sexual access and activity celebrations. Religious and social traditions are 12. The healthy family lets each child to be the person
2. provide an orderly context important to the health of a family. God created: Some families unfortunately force their
3. nurture and socialize children 3. A healthy has control of its family life. Family life has children into a mould of conformity. The motto of a
4. ascribe social status not be ruled by an outside calendar of social healthy family should be: “Be and let be” Children like
- Families further impart affection, care and adaptive celebrations and obligations, however, valuable in beautiful flowers should should grow to be; what God
functions. themselves. want them to be. Parents should be like careful
FAMILY DEVELOPMENTAL: STAGES OF THE FAMILY LIFE CYCLE: 4. A healthy family demands responsibility from all gardeners, not like ruthless stone sculptors.
1. unattached adult members towards the common needs. All family 13. The healthy family lets go. Parents shouldn’t be too
2. newly married adults/married couple without members, children included, are to be responsible much possessive, when the time comes for the child to
children towards the common needs and burdens of the leave home, let him/her go.
3. childbearing adults/families with the oldest child family.
between birth and 30 months 5. A healthy family demands mutual respect for one PUBLIC HEALTH WORKERS (PHW):
4. families with pre-school age children other. Respect thrives in the family that never Members of the health team who are professionals namely:
5. families with school-age children humiliates others, not even the smallest children, nor - Medical Officer (MO)-Physician
6. teen-age years discusses anyone’s shortcomings in front of others, - Public Health Nurse (PHN)-Registered Nurse
7. launching center belittles them or makes them victims of others’ failures. - Rural Health Midwife (RHM)- Registered Midwife
8. middle-aged adults 6. A healthy Family allows its members to do mistakes. - Dentist
9. retired adults We learn by trial and error. Do not expect the - Nutritionist
FAMILY HEALTH TASK: members of your family to be perfect from the very - Medical Technologist
- The family tasks areas include basic, developmental start - Pharmacist
and crisis tasks. 7. The healthy family is able to deal with adversity as well - Rural Sanitary Inspector (RSI)- must be a sanitary
- Basic task is concerned with the provision of food, as success. The healthy family gathers together in an engineer
money, shelter and other necessities of life. effort to deal with any problem, be it unemployment, THE RURAL HEALTH UNIT:
- Individual development stages include infancy, alcoholism, school or college failure or whatever • Primary level health facility in the municipality
childhood, adolescence, adulthood and aging. 8. The healthy family communicates. The healthy family • Focuses on preventive and promotive health services.
- Health care tasks include providing care and support enjoys sharing with one another their joys and sorrows • Supervises the BHSs
to someone with health care needs, an important not good news only but also, disappointments, failures • 1 RHU: 20,000 population
component of their role can include carrying out and dreams as well. BARANGAY HEALTH STATION:
tasks that are of clinical in nature which might include 9. Members of a healthy family spend time along with - first-contact health care facility offering basic services
caring for wounds, catheter or tracheostomy care, each other. This is the time when one person spends at the barangay
managing ventilation or the administration of time alone with another member of the family. - Manned by the RHM and BHWs
medicines. 10. The healthy family develops a sense of play and THE RHU PERSONNEL:
CHARACTERISTICS OF A HEALTHY FAMILY SUGGESTED BY FR. humour. The degree of fun and humor among families • Municipal Health Officer (MHO)
J. PIMENTA varies widely. - A.k.a. Rural Health Physician
1. The healthy family has a strong sense of family 11. The healthy family develops trust. Children must be - Administrator of the RHU
belonging. Even if the family members have to move trusted and at the same time they should know and • Community physician
 - Medico-legal officer of the municipality
- 1 MHO: 20,000 population
PUBLIC HEALTH NURSE (PHN):
• Supervises and guides all RHMs in the municipality.
• Prepares FHSIS quarterly and annual reports of the
municipality for submission to the Provincial Health
Office
• Public Health Nurse (PHN)
• Utilizes the nursing process in responding to health
care needs, including needs for health education
and promotions, of individuals, families, and
catchment community.
THE INTER-LOCAL HEALTH ZONE:
• Collaborates with the other members of the health
- Defined catchment population within a defined
team, government agencies, private businesses,
geographical area.
NGOs, and people’s organizations to address the
- Covers all sectors involved in the delivery off health
community’s health problems.
services.
• 1:20,0000 population
- Components: People; Boundaries; Health facilities;
RURAL HEALTH MIDWIFE (RHM):
Health workers
• Manages the BHS and supervises and trains the BHW.
HEALTH SYSTEM:
• Provides midwifery services and executes health care
- Consists of all organizations, people, and actions
programs and activities for women of reproductive
whose primary intent is to promote, restore, or
age.
maintain health.
• Conducts patient assessment and diagnosis for
- Building blocks: Service delivery
referral or further management.
✓ Health workforce
• Performs health information, education, and
✓ Information
communication activities.
✓ Medical products, vaccines, and technologies
• Organizes the community.
✓ Financing
• Facilitates barangay health planning and other
✓ Leadership and governance or stewardship
community health services.
FACTORS INFLUENCING THE HEALTH CARE DELIVERY SYSTEM:
• 1;5,000 population
• Health care “reforms
THE HEALTH REFERRAL SYSTEM:
• Demographics
• Referral – A set of activities undertaken by a health
• Globalization
care provide or facility in response to its inability to
• Poverty and growing disparities
provide the necessary health intervention to satisfy a
• Social disintegration
patient’s need.
1. Internal referrals – Occur within the health facility.
2. External referrals – Movement of a patient from
one health facility to another