9: THE HEALTHCARE DELIVERY SYSTEM
• A nation’s health care delivery system has a tremendous impact
not only on the health of its people but also on their total
development, including their socioeconomic status.
• A discussion of the healthcare delivery system often involves
issues of costs and challenges.
• Nations go through a struggle to overcome multiple forces in
efforts to advance the nation’s health within the context of
their financial and political situations.
• Anderson and McFarlane (2011) emphasized the role of
following factors in shaping 21st century health that further
influence healthcare delivery system
o Healthcare “reforms”
o Demographics
o Globalization
o Poverty and growing disparities
o Social disintegration
• This chapter delineates healthcare delivery system in the
Philippines. Beginning with the World Health Organization as
the specialized agency of the United Nations provides global
leadership on health matters.
• In the Philippines, health services are provided by the
government and the private sector for profit as well as
nonprofit, with the latter frequently referred to as
nongovernmental organization or NGOs.
• On the national level, direction is set by the Department of
Health (DOH). By virtue of the mandate of the Local
Government Code or RA 7160. Local government units (LGUs)
should have an operating mechanism to meet the priority
needs and services requirement of the communities.
• Basic health services are regarded as priority services, for which
LGUs are primarily responsible.
HEALTH SYSTEM
• A health system consists of all organizations, people and
actions whose primary intent is to promote, restore, or
maintain health. A health system has six building blocks or
components:
1. Service delivery
2. Health workforce
3. Information
4. Medical products, vaccines, and technologies
5. Financing
6. Leadership and governance or stewardship
• The nurse is an essential member of the health workforce in the
country. For the nurse to work efficiently within the healthcare
delivery system, an understanding of the dynamic relationship
among its components is needed.
• For example, a nurse who understands the referral system will
be able to refer patients with the appropriate facility or health
personnel.
• An appreciation of the value of the nurse’s role in the system
provides motivation to work despite sometimes seemingly
overwhelming odds.
• The study of this chapter accords a realization of the nurse’s
position in the scheme of healthcare delivery system in the
Philippines
THE WORLD HEALTH ORGANIZATION
• When diplomats formed the organization in 1945, they also
discussed the creation of a global health organization. The
World Health Organization (WHO) was the outcome of this
discussion.
• The World Health Organization (WHO) constitution came into
force on April 7, 1948. Since then, April 7 has been celebrated
each year as a World Health Day (WHO, 2013).
• With its headquarters in Geneva, Switzerland, WHO has 147
country offices and 6 world regional offices for Africa, the
Americas, Eastern Mediterranean, Europe, Southeast Asia and
the Western Pacific.
• The Philippines is a member of the Western Pacific Region,
which holds office in Manila. (WHO, 2007)
• The WHO constitution states that its objective is the attainment
by all people of the highest possible level of health (WHO,
2006).
• WHO carries out the following core functions (WHO, 2013):
✓ Providing leadership on matters critical to health and engaging
in partnerships where joint action is needed.
o WHO 193 member countries and 2 associate
members. WHO and its members work with the UN
agencies, NGOs, and the private sector (WHO, 2006).
The WHO country focus is directed toward providing
technical collaboration with member states in
accordance with each country’s needs and
capacitates (WHO, 2013).
✓ Shaping the research agenda and stimulating the generation,
translation, and disseminating valuable knowledge. The WHO
strategy on research for health has five goals (WHO, 2013):
1. Capacity in reference to capacity building to strengthen
national health research systems;
2. Priorities to focus research on priority health needs
particularly in low and middle-income countries;
3. Standards to promote good research practice and enable
the greater sharing of research evidence, tools, and
materials;
4. Translation to ensure that quality evidence is turned into
products and policy; and
5. Organization to strengthen the research culture within
WHO and improve the management and coordination of
WHO research activities.
✓ Setting norms and standards and promoting and monitoring
their implementation.
o WHO develops norms and standards for various
health and health-related issues, such as
pharmaceutical products including vaccines and
other biological products used in immunization,
practices in maternal and child care, and
environmental conditions.
✓ Articulating ethical and evidence-based policy options.
Through its Department of Ethics and Social Determinants,
WHO is involved in various issues on health ethics (WHO, 2013).
o In collaboration with other Governmental and Non-
governmental organizations, WHO has worked on
bioethical concerns such as those related to human
organ and tissue transplantations, reproductive
technology, and public health response to treat
infectious disease (e.g., AIDS, influenza, and TB).
• Providing technical supports, catalyzing change, and building
sustainable institutional capacity.
o WHO offers technical support and training to its
member countries in the fields of maternal and child
health, control of diseases and environmental health
services.
o WHO is involved in monitoring the health situation
and assessing health trends. WHO has developed
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 guidance and tools, and measurement and
monitoring and evaluation.
• The Philippines is a member of a global system of nations
interacting with each other at different levels and in different
ways. Events that happen in other countries can affect the
health status of Filipinos. Ease of travel from one part of the
globe to another makes transmission of communicable
diseases likewise easy.
• This has been proven by events as the emergence and spread
of diseases like HIV/AIDS, SARS, AH1N1 influenza (swine flu)
and recently the COVID-19.
o In contrast, cooperation and sharing of resources
among nations serve as the key in the solution of
many human problems-health and otherwise.
o WHO provides the environment and facilitates
cooperation and sharing of resources to promote and
protect health and resolve health problems and
alleviate their effects
• In the past decade, WHO has worked as a partner of the
Philippine DOH in the development and provision of services
towards the attainment of the health-related sustainable
development goals.
THE SUSTAINABLE DEVELOPMENT GOALS
• In September 2015, the General Assembly adopted the 2030
Agenda for Sustainable Development that includes 17
Sustainable Development Goals (SDGs).
• Building on the principle of “leaving no one behind”, the new
Agenda emphasizes a holistic approach to achieving sustainable
development for all.
• The SDGs also explicitly include disability and person with
disabilities 11 times.
o Disability is referenced in multiple parts of the SDGs,
specifically in the parts related to education, growth
and employment, inequality, accessibility of human
settlements, as well as data collection and the
monitoring of the SDGs.
• The year 2016 marks the first year of the implementation of the
SDGs. At this critical point, #Envision2030 will work to promote
the mainstreaming of disability and the implementation of the
SDGs throughout its 15-year lifespan with objectives to:
o Raise awareness of the 2030 Agenda and the
achievement of the SDGs for persons with disabilities;
o Promote an active dialogue among stakeholders on
the SDGs with a view to create a better world for
persons with disabilities;
o Establish an ongoing live web resource on each SDG
and disability
There are 17 Sustainable Development Goals
1. No poverty
2. Zero hunger
3. Good health and well-being
4. Quality education
5. Gender equality
6. Clean water and sanitation
7. Affordable and clean energy
8. Decent work and economic growth
9. Industry, innovation, and infrastructure
10. Reduced inequalities
11. Sustainable cities and communities
12. Responsible consumption and production
13. Climate action
14. Life below water
15. Life on land
16. Peace, justice, and strong institutions
17. Partnership for the goals
THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM
• The DOH serves as the main governing body of health services
in the country. The DOH provides guidance and technical
assistance to LGUs through the Center for Health Development
in each of the 17 regions.
o Provincial governments are responsible for
administration of provincial and district hospitals.
o Municipal and city governments are in charge of
primary care through rural health units (RHUs) or
health centers.
• Satellite outposts known as barangay health stations (BHSs)
provide health services in the periphery of the municipality or
city.
o As mentioned earlier, the Local Government Code
mandate the devolution or basic decentralization of
basic health services.
o This means the LGUs have the autonomy and
responsibility to plan and implement basic health
services (primary care) on behalf of their
constituents.
• It is a mandate for LGUs depending on the capability and
political will on the municipal or city government.
• Higher levels of services may also be provided, thus it is possible
for a city or a municipality to administer a secondary or even
tertiary hospitals.
o Example: Ospital ng Maynila Medical Center
o The tertiary hospital is funded by the city government
of Manila.
o In Cebu, there is the Vicente Sotto Memorial Medical
Center.
• The private sector composed of for-profit and non profit
agencies. This sector provides all levels of services and accounts
for a large segment of health services and providers in the
country.
o About 30% of Filipinos utilize private health facilities
o An estimated 60% of the national health expenditure
goes to the private sector.
o This sector also employs more than 70% of the health
professionals in the Philippines (Romualdez, 2011).
• Financing of health services is provided by three major groups:
a. the government (national and local),
b. private sources,
c. and social health insurance.
• The leading payment scheme is out-of-pocket, accounting for
40-50% of the total health expenditure.
• The National Health Insurance Act of 1995 (R.A. 7875) created
the Philippines Health Insurance Corporation (PhilHealth).
o It isa tax-exempt government corporation attached
to the DOH policy coordination and guidance, and
aims for universal health coverage of all Filipino
citizens (Congress of the Republic of the Philippines,
1995).
THE DEPARTMENT OF HEALTH
• The Department of Health (DOH) is the national agency
mandated to lead the health sector towards assuring quality
health care for all Filipinos.
• The DOH vision is to be a global leader for attaining better
health outcomes, competitive and responsive healthcare
system, and equitable health financing.
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• Its mission statement is to guarantee equitable, sustainable, • Excellence
and quality health for all Filipinos, especially the poor, and to • Compassion and respect for human dignity
lead the quest for excellence in health (DOH, 2012). • Commitment
• In the pursuit of its mission, the DOH has the following major • Professionalism
roles: (1) leader in health, (2) enabler and capacity builder, and • Teamwork
(3) administrator of specific services. • Stewardship of the health of the people
• The leadership role of the DOH is specifically elucidated in
Executive Order 102, series of 1999 in terms of the following • DOH carries its work through the various central bureaus and
functions: services from the central office, centers of health development
1. Planning and formulating policies of health programs and from other regions, DOH attached agencies, and DOH attaches
services hospitals as well
2. Monitoring and evaluating the implementation of health
programs, projects, research, training, and services; LEVELS OF HEALTH CARE DELIVERY
3. Advocating for health promotion and healthy lifestyles; • Advances in health sciences and services have brought about the
4. Serving as a technical authority in disease control and development of different types of health facilities. In response,
prevention; and the DOH issued Administrative Order 2012-0012 (Rules and
5. Providing administrative and technical leadership in health Regulations Governing the New Classification of the Hospitals
care financing and implementing the National Health and Other Health Facilities in the Philippines) that provides for a
Insurance Law. new classification scheme of health facilities.
• As enabler and capacity builder, the DOH performs the • Although the levels of health care delivery are basically the
following functions: same. Primary, secondary, and tertiary, the classification of
1. Proving logistical support to LGUs, the private sector, and hospitals have changed
other agencies in implementing health programs and Hospitals are broadly classified as general or specialty hospitals:
services. • General Hospital provides services for all kinds of illnesses,
2. Serving as the lead agency in health and medical research’ injuries or deformities.
and • Specialty Hospital offers services for a specific disease or
3. Protecting standards of excellence in the training and condition or type of patient, such as children, the elderly, or
education of health care providers at all levels of the health women (DOH, 2012)
care system.
• To administer of specific services, the DOH is tasked to: HOSPITAL OTHER HEALTH FACILITIES
1. Serve as administrator of selected health facilities at General
subnational levels that act as referral centers for local - Level 1 A. Primary Care Facility
health systems, that is tertiary and special hospitals, - Level 2 B. Custodial Care Facility
reference laboratories, training centers, centers for health - Level 3 C. Diagnostic/Therapeutic
promotion, centers for disease control and prevention and (Teaching/Training) facility
regulatory offices;
Specialty D. Specialized Outpatient
2. Provide specific program components for conditions that
Facility
affect large segments of population, such as tuberculosis,
malaria, schistosomiasis, HIV/AIDS, and micronutrient
DOH Administrative Order 2012-0012 classifies other health facilities
deficiencies.
as follows:
3. Develop strategies for responding to emerging health
needs; and
Category A. Primary Care Facility – a first-contact health care facility
4. Provide leadership in health emergency preparedness and
that offers basic services including emergency services and provision
response services, including referral and networking
for normal deliveries.
systems for trauma, injuries, and catastrophic events.
1. Without in-patient beds like health centers, out-patient
clinics, and dental clinics.
2. With in-patient beds- a short-stay facility where the patient
spends on the average of one to two days before discharge.
Examples are infirmaries and birthing (lying-in) facilities.

Category B. Custodial Care Facility – a health facility that provides

long-term care, including basic services like food and shelter, to
patients with chronic conditions requiring on going health and
nursing care due to impairment and a reduced degree of
independence in activities of daily living, and patients in need of
rehabilitation.
• Examples are custodial psychiatric faculties, substance/drug
abuse treatment and rehabilitation centers,
sanitaria/leprosaria and nursing homes.
The DOH core values reflect adherence to the highest standards of
Category C. Diagnostic/Therapeutic Facility – a facility for the
work, namely:
examination of the human body, specimens from the human body
• Integrity
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for the diagnosis, sometimes treatment of disease, or water for First-level x- Second-level x-ray Third-level x-ray
drinking analysis. The test covers the preanalytical, analytical, and ray with mobile unite
postanalytical phases of examination.
• Category C is further classified into: Pharmacy
1. Laboratory facilities, such as, but not limited to the
following: THE RURAL HEALTH UNIT
a. Clinical laboratory • The Rural Health Unit (RHU), commonly known as a health
b. HIV testing laboratory center, is a primary level health facility in the municipality
c. Blood service facility • The recommended ration of RHU to catchment population is
d. Drug testing laboratory 1RHU:20,000 population (DOH, 2009).
e. Newborn screening laboratory • The BHS is the first contact health care facility that offers basic
f. Laboratory for drinking water analysis services at the barangay level.
2. Radiologic facility providing services such as X-ray, Ct scan, It is a satellite station of the RHU.
Mammography, MRI, and ultrasonography. It is manned by volunteer Barangay Health Workers (BHWs)
3. Nuclear medicine facility – a facility regulated by the under the supervision of the Rural Health Midwife (RHM) (DOH,
Philippine Nuclear Research Institute utilizing applications 2001)
of radioactive materials in diagnosis, treatment, or medical
research, with the exception of the use of sealed radiation THE RURAL HEALTH UNIT PERSONNEL
sources in radiotherapy as an internal radiation therapy. The Municipality Health Officer (MHO) or Rural Health Physician
heads the health services at the municipal level and carries out the
Category D. Specialized Outpatient Facility – a facility that performs following roles and functions:
highly specialized procedures on an outpatient basis 1. Administrator of the RHU
• Examples: dialysis clinic, ambulatory surgical clinic, cancer a. Prepare the municipal health plan and budget
radiation facility (chemotherapy), and physical medicine and b. Monitors the implementation of basic health services
rehabilitation center/clinic. c. Management of the RHU staff
2. Community Physician
HOSPITALS LEVEL 1 LEVEL 2 LEVEL 3 a. Conducts epidemiological studies
b. Formulates health education campaigns on disease
Example: Example: Mindoro Example: Cebu
prevention
Saint Medical Health Velez General
Anthony Center Hospital c. Prepares and implements control measures or
Mother and rehabilitation plans.
Child 3. Medico-legal officer of the municipality (DOH, 2001)
Hospital
(Cebu) The revised implementing rules and regulation (IRRs) of R.A. 7305 or
Level 1 plus: Level 2 plus: the Magna Carta of Public health Workers stipulate that there be one
Consulting Departmentalized Teaching/training (1) rural health physician to a population of 20, 000 (DOH, 1999)
specialists clinical services with accredited
in: residency training The Public Health Nurse (PHN)
- Medicine program in four 1. Supervises and guides all RHMs in the municipality.
- Pediatrics major clinical 2. Prepares the FHSIS quarterly and annual reports in the
- Obstetrics- services municipality for submission to the Provincial health Office.
Gynecology 3. Utilizes the nursing process on responding to health care
needs, including needs for health education and
Clinical promotions of individuals, families, and catchment
services Emergency Respiratory unit Physical medicine community;
for and and rehabilitation 4. Collaborates with other members of the health team,
inpatients Outpatient unit government agencies, private businesses, NGOs, and
services people’s organizations to address the community’s health
Isolation General ICU problems
facilities R.A. 7305 IRRs provide for the same nurse-population ratio as that of
Surgical High-risk Ambulatory the Rural Health Physician, that is, 1:20,000.
maternity pregnancy unit surgical
facility With a recommended ratio of 1 for every 5, 000 population, the RHM
Dental clinic NICU Dialysis clinic (Rural Health Midwife):
1. Manages the BHS and supervises and trains the BHW;
Secondary Tertiary clinical Tertiary clinical 2. Provides midwifery services and executes health care
Ancillary Clinical laboratory laboratory with programs and activities for women of reproductive age,
services laboratory histopathology including family planning and services;
3. Conducts patient assessment and diagnosis for referral or
Blood Blood Bank
further management;
Station
4. Performs health information, education, and
communication activities;
5. Organizes the community; and
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 6. Facilitates barangay health planning and other community
health services
• The functions of the Rural Sanitary Inspector are directed
towards ensuring a healthy physical environment in the
municipality.
o This entails advocacy, monitoring and regulatory
activities, such as inspection of water supply and
unhygienic household conditions.
• BHWs are considered as the interface between the community
and the RHU. They are trained in preventive health care with a
strong emphasis on maternal and childcare, family planning and
reproductive health, nutrition, and sanitation.
o Although they carry the status of volunteers, R.A. 7883
or the Barangay Health Workers’ Benefit and
Incentives Act entitles them to hazard pay and
subsistence allowances and other benefits.
o The recommended ratio of BHW to catchment
population is 1 BHW:20 household (DOH, 2009).
LOCAL HEALTH BOARDS
• R.A. 7160 or Local Government Code was enacted to bring
about genuine and meaningful local autonomy.
• This will enable local governments to attain their fullest
development as self-relying communities and make them more
effective partners in the attainment of national goals
• It mandated devolution of basic services from the national
government to LGUs.
• Devolution refers to the act by which the national government
confers power and authority upon the various LGUs to perform
specific function and responsibilities.
• R.A. 7160 provided for the creation of the Provincial Health
Board and the City/Municipal Health Boards, or Local Health
Boards
The chairman of the board is the Provincial Governor /
the local executive Mayor
Vice chairman The Provincial / City / Municipal
Health Officer
Are composed of the chairman
of the committee on health of
Sanggunian, a representative
Members of the board from the private sector or NGO
involved in health services, and
a representative of the DOH
The functions of local health boards are as follows:
1. Proposing to the Sanggunian annual budgetary allocations
for the operation and maintenance of health facilities and
services within the province/city/municipality;
2. Serving as an advisory committee to the Sanggunian on
health matters; and
3. Creating committees that shall advise local health agencies
on various matters related to health services operations
HEALTH REFERRAL SYSTEM
• Implemented since 1992
• Brought decision-seeking and accountability on basic
government services closer to the people
• Allowed local leaders to have a greater hand in the future of local
communities. However, it has brought about fragmentation of
the healthcare delivery system in the Philippines
o It resulted in a three-level system where local and
national governments are responsible for independent
services
o Municipalities / cities began operating separately from
each other, causing further segregation of public health
services
• Certain provisions of the Local Government Code deal with
relations of local and national government
o These provisions present a built-in mechanism for a
referral system among different government agencies
• A referral is a set of activities undertaken by a health care
provider or facility in response to its inability to provide the
necessary health intervention to satisfy a patient’s need
• A functional referral system is one that ensures continuity and
complementation of health and medical services
o It is comprehensive and promotive, preventive, curative,
and rehabilitative care
o It also engages all health facilities from the lowest to the
highest level
o It usually involves movement of a patient from the health
center at first contact and the hospital at first referral level
• Two-way referral system – When a hospital intervention has
been completed, the patient is referred back to the health center
Referrals may be internal or external:
1. Internal referrals – occur within the health facility, from one
health personnel to another.
o Examples of internal referral are RHM to PHN and PHN to
MHO.
o An internal referral may be made to request for an opinion
or suggestion, co-management, or further management or
specialty care.
2. External referrals – is a movement of a patient from one health
facility to another.
o It may be vertical, where the patient referral may be from
a lower to a higher level of health facility or the other way
round.
o The referral may be horizontal, where the patient is
referred between similar facilities in different catchment
areas.
Comprehensive two-way referral system
THE INTER-LOCAL HEALTH ZONE
• As stated earlier, devolution has resulted in fragmentation of
healthcare delivery systems. As segregation of public health
services among different LGUs continues, the referral system
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 functions within the context of the inter-local health zone or ILHZ
which provides means for consolidating healthcare efforts
• The Inter-local health zone (ILHZ) is based on the concept of the
District Health System
o District Health System is a generic term used by WHO to
describe an integrated health management and delivery
system based on a defined administrative and
geographical area
• An ILHZ has a defined catchment population within a defined
geographical area. It has a central or co-referral hospital and a
number of primary level facilities such as RHUs and BHSs
• The ILHZ does not only cover government health services but
also all other sectors involved in the delivery of health services.
It may include the community-based NGOs and private sectors
both local and foreign.
• Not synonymous with a political congressional district, an ILHZ
may be composed of one large municipality or several
municipalities
• It has the following components:
o People – although WHO has described the ideal
population size of a health district between 100,000 and
500,000, the number of people may vary from zone to
zone, especially when taking into consideration the
number of LGUs that will decide to cooperate and cluster
o Boundaries – Clear boundaries between ILHZs establish
accountability and responsibility of health service
providers
o Health facilities – RHUs, BHSs, and other health facilities
that decide to work together as an integrated health
system and a district and a provincial health hospital,
serving as the central referral hospital, make up the
health facilities of an ILHZ
o Health workers – to deliver comprehensive services, the
ILHZ health workers include personnel of the DOH, district
or provincial hospitals, RHUs, BHSs, private clinics,
volunteer health workers from NGOs, and community-
based organizations
A Diagrammatic Representation of an Inter-Local Health Zone
• The local government of 3 adjacent municipalities and an NGO is
offering custodial care to an elderly person who have agreed to
consolidate their healthcare system into a health cluster.
• The cluster provides primary health services and custodial care
to a population of 165,000.
• The cluster has established a linkage with a district hospital,
which now serves as the central referral hospital of the ILHZ.
HEALTH SECTOR REFORM: UNIVERSAL HEALTH CARE
• On February 2019, President Rodrigo Duterte signed the
Universal Health Care Bill into law (Republic Act No. 11223),
ushering in massive reforms in the Philippine health sector.
• Among the salient features of the UHC Law are the expansion of
population, service, and financial coverage through an array of
health system amendments.
• With UHC, all Filipinos are guaranteed equitable access to quality
and affordable health care goods and services, and protected
against financial risk.
Rationale for Health Sector Reforms
• Health sector reforms are intended to bring about equity in
health service delivery
• Survey data show that this has not been achieved as of yet,
despite health sector reforms since 1999.
• A DOH and PhilHealth review highlighted the need to improve
health-related financial risk protection among Filipinos. More
importantly, PhilHealth benefit delivery was found to be lowest
among the target population—the poorest quintile.
• Population quintiles are determined in this manner:
o During an NSO survey, a wealth index is constructed by
assigning a weight to each household asset.
o These scores are summed by household. Individuals are
ranked according to the total score of the household in
which they reside.
o The sample is then divided into five groups (quintiles),
with each group having the same number of individuals
(NSO, 2009).
• Neglect of public hospitals and health facilities due to
inadequate health budgets has been observed.
• As of October 2010, a total of 892 RHUs and 99 government
hospitals had yet to qualify for accreditation by PhilHealth.
o Data shows that the poorest of the population are the
main users of government health facilities
o This means that the deterioration and poor quality of
many government health facilities is particularly
disadvantageous to the poor who needs the services the
most.
ALL FOR HEALTH TOWARDS HEALTH FOR ALL: Goals and Objectives
1. Financial protection:
Filipinos, especially the
poor, marginalized, and
vulnerable are protected
from high cost of health care
2. Better health outcomes:
Filipinos attain the best
possible health outcomes
with no disparity
3. Responsiveness: Filipinos
feel respected, values, and
empowered in all of their interaction with the health system
ALL FOR HEALTH TOWARDS HEALTH FOR ALL: Strategic Thrusts
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
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 Enforce standards,
E accountability, and
transparency
Value all clients and patients,
V especially the poor,
marginalized, and vulnerable
Elicit multi-sectoral and multi-
E stakeholder support for
health

PUBLIC HEALTH PROGRAMS

1. Reproductive and maternal health: pregnancy services and care
during pregnancy, delivery, and postpartum period
2. Expanded Grantisadong Pambata (child health): Advocacy for
exclusive breastfeeding in the first 6 months of life, newborn
screening program, immunization, nutrition services, and
integrated management of childhood illness
3. Control of communicable diseases such as tuberculosis,
mosquito-borne diseases, rabies, schistosomiasis, and sexually
transmitted infections
4. Control of noncommunicable or lifestyle diseases
5. Environmental health referral system, especially through the
ILHZs, consolidates the fragmented health care delivery system

✓ Knowing one’s role in the system enables one to contribute

effectively to the system goals. A thorough understanding of the
healthcare delivery system in the country will better equip the
nurse practitioner in the Philippines, regardless of the work
setting in providing integrated care to the client.