1F: Primary Health Care - (Medical consultation,

first-aid, urgent care,

immunization)
Health - The first contact of people with health
- Basic human right services that are continuous,
- “Everyone has a right to a standard comprehensive and coordinated, been
living adequate for the health and focused on treating illness as and
well-being of himself and of his family, when it arises rather than preventing
including food, clothing, housing and disease (Beard, 2014)
medical care and necessary social
services, and the right to security in BRIEF HISTORY OF PHC
the event of unemployment, sickness, ● 1978 (Sept 6-12) Alma Ata, USSR –
disability, widowhood, old age, or International Conference for PHC
other lack of livelihood in ○ The group leaders (WHO and
circumstances beyond his control. UNICEF) expressed the need
(Universal Declaration of Human for concerted efforts by all
Rights, Article 25, Section 1).” governments and health and
- Health with its definition came into development workers for the
the evolution of the creation of protection and promotion of
Primary Health Care or/and having health of all people
Primary Health Care would mean that ○ Alma Ata Declarations on
it is readily accessible/available to all Primary Health Care
or to everyone regardless of creed, Health is a basic
status, and social economic fundamental right
background. The exists global
burden of health
inequalities among
populations
Economic and social
development is of
Primary Care basic importance for
- Provision of interventions to cure the full attainment of
specific conditions of individuals at Health for all
the level of the community level Governments have a
- First level of healthcare delivery in responsibility for the
which a generalist (physician or health of their people
nurse) renders medical and nursing ● Ultimate Goal: “Health for All” by
services for individuals and year 2000
population groups.
- ex: gov’t owned clinics or 5 Elements in achieving the goal of “health
privately owned clinics for all”
● Universal coverage
 ○ reductions of exclusion and
social disparities in health /
accessibility of health for
everyone
● Health service reforms
○ when there is organized
health services around
people’s needs and
expectation, so there will be
now branching out specific
agencies that would be able to
address the Health concern of
the individual
● Public policy reforms
○ Integration of Health into all
sectors
● Leadership reforms
○ purses collaborative models of
policy dialogue
○ the economic or economy of
the country goes hand in hand
with the health of the people
● Increasing stakeholder participation
○ the person now or the
individuals are actively
participating
○ becoming more “self-reliant”
1979: Letter of instructions 949 by Former
Pres. Marcos
- underscored the need to promote
health development in rural areas and
to integrate health in all government
activities
Dimension of PHC
Primary Health Care
- 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 through their full
participation and at a cost that the
community can afford to maintain at
every stage of their development in
the spirit of self-reliance and
self-determination (WHO/UNICEF
1978, in Stanhope and Lancaster,
1992:172)
- points that the community,
individually, and the families
of the community are able to
make healthcare more
accessible, affordable, and that
these individuals and families
in the community actively
participates on every stage
- The first level of contact of
individuals, the family and community
with the national health system
bringing health care as close as
possible to where people live and
work, and constitutes the first
element of a continuing health care
process (WHO, 1981)
- healthcare is being set-up
nearer to the people especially
to those in isolated areas for
more accessibility
- KEY FEATURE: Brings healthcare
closer to people
- ensure people’s health by fostering
active community participation and
establishing partnership among all
sectors of society in working for
better health
➢ Goal: PHC seeks to ensure that all
people regardless of age, sex, creed,
relgion, ideology, and race are
provided acess to basic health
services
○ “Health for All”
➢ Strategy: promotes collaboration
among all sectors in society and
 values partnership between public
and private organizations
○ linkages and connections
➢ Philosophy: guides public health
practitioners to rally communities to
assume responsibility for their health
and to involve themselves in issues
affecting their health.
Concept of PHC
➢ accessibility, community participation
or partnership, appropriate
technology and multisectoral linkage
○ all integrated into community
health nursing practice
Core Values of PHC
● Social Justice
● Equity
● Respect for Human Dignity and
Human Rights
● Solidarity
● Self-reliance
Essential Health Services “EIEMENTS”
1. Education, Health
2. Immunization
3. Essential medicines/Drugs
4. Mother and child health services
5. Endemic disease control and
management
6. Nutrition
7. Treatment of simple conditions
8. Sanitation and access to safe water
supply
Elements of PHC
1. Primary care and essential public
health functions as the core of
integrated services
2. Multisectoral policy and action
3. Empowered people and communites
Support Mechanisms
The 4 As of PHC
1. Accessibility
a. Refers to the physical distance
of health facility or the travel
time required for people to get
the needed or desired health
services
b. must be within 30 minutes
from the communities
2. Affordability
a. a matter of whether the
community or government
can afford the services and not
just the individual or family’s
capacity to pay for the health
services
b. “out-of-pocket expenses for
health care”
3. Acceptability
a. The health care offered is in
consonance with the
prevailing culture and
traditions of the populations
4. Availability
a. The basic health services
required by the people are
offered in the health care,
facilities, or is provided on a
regular or organized manner
i. ex. Botika ng Bayan,
Ligtas sa Tigdas
5. Appropriate Technology (an add-on)
a. Refers to the technology that
is suitable to the community
that will use it.
 - The resources for essential health
services come from 3 major entities:
the people themselves, the
government, and the private sector
like NGOs and socio-civic and faith
groups
- Promotes better outputs on
the health programs and
projects
Multisectoral Approach
- The PHC requires communication and
cooperation and collaboration within
and among various sectors
- Intrasectoral Linkages
- refers to the
communication,
cooperation, and
collaboration within
the health sector
among the members of
the health team and
among the health
agencies
- Intersectoral Linkages
- team approach utilized
by the personal of
health center in
dealing with
conditions and
problems
- two-way referral
system
- same sector
Community Participation
- An educational and empowering
process in which people, in
partnership with those who are able
to assist them, identify the problems,
and the needs and increasingly
assumer responsibilities themselves
to plan, manage, control, and assess
the collective actions that are proved
necessary
R.A. 7160
- The local government code of the
Philippines that emphasizes
participatory governance and shared
leadership with the people.
Equitable distribution of health resources
- The PHC calls for an inventory and
analysis of health resources, facilities,
and manpower
- Programs done by DOH to ensure the
equitable distribution of manpower to
the rural areas
- Doctor to the Barrios (DTTB)
Program
- REgistered Nurses Health
Enhancement and Local
Services (RN Heals)
Difference between Primary Health Care and
Primary Care
PHC
● Focus Client: Family and community
● Focus of Care: Promotive and
preventive through community
participation
● Decision-making process: Community
centered/consultative-participative
● Outcome: self-reliance
● Setting for services: Rural based,
satellite clinics, community health
centers, health posts that are
accessible to all
● Goal: Development and preventive
care
Primary Care
● Focus Client: Individual
 ● Focus of Care: Curative provided by
health professionals
● Decision-making process: Health
worker driver
● Outcome: Reliance on health
professionals to restore/regain health
● Setting for services: Most
urban-based: hospitals, clinics
● Goal: Absence of disease
Aims of the Aquino Health Agenda (AHA):
Achieving Universal Health Care for ALL
➢ a focused approach to health reform
implementation in the context of
HSRA (Health Sector Reform Agenda)
and F1 (FOURmula One in 2005),
ensuring that all Filipinos, especially
the poor, shall be attained by pursuing
the three strategic thrust:
1. Financial risk protection
through expansion in National
Health Insurance Program
(NHIP) enrollment and benefit
delivery
a. Protection from the
financial impacts of
health care is attained
by making any Filipino
eligible to enroll, to
know their
entitlement and
responsibilities, to
avail of health
services, and to be
reimbursed by
PhilHealth with regard
to health care
expenditures
2. Improved access to quality
hospital and health care
facilities
a. Achieved through the
following approaches:
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
3. Attainment of the
health-related Millennium
Development Goals (MDGs)
a. The organization of
Community Health
Teams (CHT) in each
priority population
area is one way to
achieve health related
MDGs
b. CHTs are groups of
volunteers, who will
assist families with
their health needs,
provided health
information, and
facilitate
communication with
other health providers
c. Coordination among
gov’t agencies such as
DOH, DepED, DSWD,
and DILG, would also
be essential for the
achievement of these
MDGs
AHA: How to know if it is successful?
- It’s success is measure by:
- The progress made in
preventing premature deaths
 - Reduce maternal and
newborn deaths
- Controlling both
communicable and
non-communicable diseases
- Improvements in access to
quality health facilities and
services
- Increasing NHIP benefit
delivery rate, prioritizing the
poor and the marginalized
population
Universal Health Care Law or Kalusugan
Pangkalahatan (KP)
- Universal Health Care Act and its IRR
(Local Health Systems Provisions)
- Republic Act 11223 (February 20,
2019 signed by Pres. R. Duterte)
- Aim: to protect and promote the right
to health of all Filipinos and instill
health consciousness among them
General Objectives
- To progressively realize UHC through
systemic approach and clear role
delineation of stakeholders
- To ensure equitable access to quality
and affordable health care and
protection against financial risk
Principles:
- Integrated and comprehensive
approach to ensure health literacy,
healthy living, and protection for
hazards and risks
- Whole-of-system,
whole-of-government,
whole-of-society approach in the
development of health policies
- Health care model that provides
comprehensive health services
without causing financial hardship
- People-oriented approach centered
on people’s needs and well-being
UHC does NOT mean “Tanan Libre”
- Every Filipino family is matched to a
primary care team, who ensures that
they get the appropriate services they
need in the appropriate facility
- Every Filipino family’s health
spending is predictable; PhilHealth
ensures they are protected from
financial risk
UHC Coverage
1. Population Coverage
a. automatic inclusion of every
Filipino citizen into the NHIP
2. Service Coverage
a. Immediate eligibility and
access to population-based
and individual-based health
services
b. Comprehensive outpatient
benefit package
c. Provision of Primary Care
Provider
3. Financial Coverage
a. Population-based Health
Services
i. funded by National
Government through
DOH
ii. free at point of
services
b. Simplification of NHP
membership
i. Direct contributors -
those who have the
capacity to pay
premiums
ii. Indirect contributors -
those whose
premiums are
 subsidized by the - Considerations:
National Government - Income Class
c. Individual-based Health - Poverty Incidence
Services: - Local Capacity
i. funded primary - Availability of Services and
through pre-payment Commodities in the Local
mechanisms (SHI, PHI, Market
HMO) - UHC Act and Pertinent Laws
d. Pooling funds to PhilHealth for - Not Affected by Re-Devolution
all individual-based health - DOH Hospitals and Other
services National Health Facilities
- Attached Agencies and
Aims of the Mandanas-Garcia Ruling and the Corporations
DOH Initial Devolution Transition Plan
- Executive Order No. 138, “Full Principles for Retention of Functions with
Devolution of Certain Functions of DOH
Executive Branch to Local - Leader in Health
Governments” - Enabler and capacity builder
- Key Features: - Administrator of National Health
- Delineation of NG and LGU Facilities, Attached Agencies, and
Roles Corporations
- Preparation of Devolution - Financier of Population-Based Health
Transition Plans Services
- Creation of Committee on
Devolution
- Development of
Communication Plan and
Strategy
- Capacity Building for LGUs
- Strengthening of Planning,
Investment Programming, and
Budgeting Linkage and M&E
Systems
- Establishment of Growth
Equalization Fund
- Options for Affected NGA
Personnel

Overview of the Initial DOH Devolution

Transition Plan
- Health System has a Devolved Set-up
- Re-devolution of functions, not
necessarily downloading of funds