MODULE 2- The Health Care Delivery System

A. World Health Organization – a specialized agency of the United Nations that provides
global leadership on health matters.
Head Office – Geneva Switzerland 147 country offices / 6 world regional offices
6 World Regional Offices:
a. Africa
b. The Americas Eastern Mediterranean
c. Europe
d. Southeast Asia
e. Western Pacific
1. Millennium Development Goals
Goal 1: Eradicate extreme poverty and hunger
Goal 2: Achieve universal primary education
Goal 3: Promote gender equality and empower women
Goal 4: Reduce child mortality
Goal 5: Improve maternal health
6: Combat HIV/AIDS, malaria and other diseases
7: Ensure environmental sustainability
Goal 8: Develop a global partnership for development
2. Sustainable Development Goals
B. Philippine Department of Health – the national agency mandated to lead the health sector
towards assuring quality health care for all Filipino.
The main governing body of health services in the country.
1. Vision: To be a global leader for attaining better health outcomes, competitive and
responsive health care system, and equitable
financing.
2. Mission: To guarantee equitable, sustainable and
quality health for all Filipinos, especially the poor,
and to lead the quest for excellence in health.
3. Historical Background
4. Local Health System and Devolution of Health
Services – Local Government Code – this means that
the LGU’s have the autonomy and responsibility to plan and implement basic health
services (primary care) on behalf of their constituents.
5. Major Roles of DOH
a. Leader in Health
b. Enabler and Capacity Builder
c. Administrator of Specific Services
6. Classification of Health Facilities AO 2012-0012
Category A – Primary Health Care – a first contact health care facility that offers basic
services including emergency services and provision for normal deliveries.
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 ongoing health and nursing are due to impairment and a reduced degree of
independence in activities of daily living, and patients in need of rehabilitation.
Example: drug abuse treatment and rehabilitation centers, sanitaria/leprosaria, and
nursing homes.
Category C – Diagnostic/ therapeutic Facility – a facility for the examination of the
human body, specimens from the human body for diagnosis, sometimes treatment of
disease, or water for drinking analysis. The test covers the preanalytical, analytical,and
post analytical phases of examination.
a. Laboratory Facility
b. Radiologic Facility
c. Nuclear Medicine Facility
Category D – Specialized Outpatient Facility – a facility that performs highly specialized
procedures on an outpatient basis. Examples are dialysis clinic, ambulatory surgical clinic,
cancer chemotherapeutic center/clinic, cancer radiation facility and physical medicine and
rehabilitation center / clinic.

7. Philippine Health Agenda 2010 – 2022 /

Healthy Philippines 2022
Motto: All for Health towards Health for All –
Lahat Para sa Kalusugan! Tungo sa
Kalusugan Para sa Lahat
Goals: The Health System Aspire For:
 FINANCIAL PROTECTION - Filipinos,
especially the poor, marginalized, and
vulnerable are protected from high cost of
health care
 BETTER HEALTH OUTCOMES - Filipinos attain the best possible health outcomes
with no disparity
 RESPONSIVENESS GOALS - Filipinos feel respected, valued, and empowered in all of
their interaction with the health system
Values:
 EQUITABLE & INCLUSIVE TO ALL
 PROVIDES HIGH QUALITY SERVICES
 USES RESOURCES EFFICIENTLY
 TRANSPARENT & ACCOUNTABLE
Milestone - During the last 30 years of Health Sector Reform, we have undertaken key
structural reforms and continuously built on programs that take us a step closer to our
aspiration.
 Devolution
 Use of Generics
 Milk Code
 PhilHealth (1995)
 DOH resources to promote local health system development Milestones
 Fiscal autonomy for government hospitals
 Good Governance Programs (ISO, IMC, PGS)
 Funding for UHC
Persistent Inequities in Health Outcomes
 2000 Every year, around 2000 mothers die due to pregnancy-related complications.
 Three out of 10 children are stunted.
 A Filipino child born to the poorest family is 3 times more likely to not reach his 5th
birthday, compared to one born to the richest family.
Restrictive and Impoverishing Healthcare Costs,
 Every year 1.5 million families are pushed to poverty due to health care expenditures
 Filipinos forego or delay care due to prohibitive and unpredictable user fees or co-
payments (Tiisin ko na lang ito)
 Php 4,000/month healthcare expenses considered catastrophic for single income families
Poor quality and undignified care synonymous with public clinics and hospitals
 Long wait times
 Less than hygienic restrooms, lacking amenities
 Poor record-keeping
 Overcrowding & under-provision of care
 Privacy and confidentiality taken lightly
 Limited autonomy to choose provider
Ambisyon Natin 2040
a. Investing in People
b. Protection Against Instability
 UNIVERSAL HEALTH COVERAGE
 STRENGTHEN IMPLEMENTATION OF RPRH LAW
 WAR AGAINST DRUGS
 ADDITIONAL FUNDS FROM PAGCOR
PHILIPPINE HEALTH AGENDA FRAMEWORK Goals:
 Attain Health-Related SDG Targets
 Financial Risk Protection,
 Better Health Outcomes
 Responsiveness
Values:
 Equity
 Efficiency
 Quality
 Transparency
STRATEGY: ACHIEVE
  Advance health promotion, primary care and quality
 Cover all Filipinos against financial health risk
 Harness the power of strategic HRH (Human Resource for Health)
 Invest in eHealth and data for decision-making
 Enforce standards, accountability and transparency
 Value clients and patients
 Elicit multi-sectoral and multi-stakeholder support for health

3 GUARANTEES:
#1 ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE GUARANTEE (Services for Both
the Well & the Sick)
#2 SERVICE DELIVERY NETWORK GUARANTEE (Functional Network of Health
Facilities)
#3 UNIVERSAL HEALTH INSURANCE GUARANTEE (Financial Freedom when Accessing
Services)

C. Primary Health Care Approach

1. Definition: “Essential health care made universally accessible to individuals and families
by means acceptable to them, through full participation and at cost that the community
and country can afford at every stage of development.”
WHO
2. Goal: Health for all Filipinos and Health in the hands of the people by the year 2020
3. Mission: to strengthen the health care system by increasing opportunities and supporting
conditions wherein people will manage their own health care
4. Concept: Primary Health Care (PHC) characterized by partnership and empowerment of
people shall permeate as core strategy in effective provision of essential health services
5. Legal Basis:
 Letter of Instruction (LOI) 949: signed on Oct. 19, 1979 by then Pres. Ferdinand E.
Marcos
 Historical Background
- 1974- WHO and UNICEF conducted a joint study
- 1975- World Health Assembly passed a resolution giving priority to the
development of PHC
- 1977- World Health Assembly decided that main target of government and WHO
is the attainment of the level of health that would allow or permit them to lead a
socially and economically productive life by year 2000
- September 6-12, 1978- 1st International Conference on Primary Health Care in
Alma Ata, USSR
- 1979- WHA launched global strategy to attain health for all
- 1980- PHC endorsed for implementation by respective regional community
6. Elements of PHC:
Education for Health
 Is one of the potent methodologies for information dissemination. It promotes the
partnership of both the family members and health workers in the promotion of health
as well as prevention of illness.
Locally Endemic Disease Control
  The control of endemic disease focuses on the prevention of its occurrence to reduce
morbidity rate. Example Malaria Control and Schistosomiasis Control
Expanded Program on Immunization
This program exists to control the occurrence of preventable illnesses especially of
children below 6 years old.

 Immunizations on poliomyelitis, measles, tetanus, diphtheria and other preventable

disease are given for free by the government and ongoing program of the DOH
Maternal and Child Health and Family Planning
 The mother and child are the most delicate members of the community. So the
protection of the mother and child to illness and other risks would ensure good health
for the community. The goal of Family Planning includes spacing of children and
responsible parenthood.
Environmental Sanitation and Promotion of Safe Water Supply
 Environmental Sanitation is defined as the study of all factors in the man’s
environment, which exercise or may exercise deleterious effect on his well-being and
survival. Water is a basic need for life and one factor in man’s environment. Water is
necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is
necessary for basic promotion of health.
Nutrition and Promotion of Adequate Food Supply
 One basic need of the family is food. And if food is properly prepared then one may
be assured healthy family. There are many food resources found in the communities
but because of faulty preparation and lack of knowledge regarding proper food
planning, Malnutrition is one of the problems that we have in the country.
Treatment of Communicable Diseases and Common Illness
 The diseases spread through direct contact pose a great risk to those who can be
infected. Tuberculosis is one of the communicable diseases continuously occupies the
top ten causes of death. Most communicable diseases are also preventable. The
Government focuses on the prevention, control and treatment of these illnesses.
Supply of Essential Drugs
 This focuses on the information campaign on the utilization and acquisition of drugs.
 In response to this campaign, the GENERIC ACT of the Philippines is enacted. It
includes the following drugs: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol,
Nifedipine, Rifampicin, INH (isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
 Dental Health Promotion
 Access to and use of hospitals as Centers of Wellness
 Mental
7. Cornerstone/Pillar inPHC:
 Multi-Sectoral Approach
a. Intrasectoral linkages
• Sectors most closely related to health
• Agriculture, education, public works, local governments, social welfare,
population control, private sectors
b. Intersectoral linkages
 Community participation
 a. Identify problem
b. Identify solution
c. Mobilizing resources
d. Barriers
 Appropriate Technology 6 criteria:
a. effectiveness and safety
b. less complex
c. less costly
d. broader scope of technology
e. acceptability to local culture
f. feasibility
 Community involvement (Involvement level):
a. Individual
b. Family-monitor growth and development of child and able to address to problems
in government
c. Community- organizations formed to promote health development
8. Principles of PHC
 Accessibility, acceptability, availability, and affordability of health services
a. Health services are delivered where people live and work
b. Development of indigenous or resident volunteer health workers to provide
healthcare with an ideal ratio of 1:10-20 households
c. Use of low cost, appropriate technology sustainable by community
d. Combined utilization of traditional medicines and essential drugs
 Partnership between community and health agencies in provision of quality, basic and
essential health services
a. Community needs and priorities are basic for planning health services and
activities
b. Training curriculum of community health workers based on community health
problems and task analysis of community health workers
c. Regular supervision and periodic evaluation of community health workers’
performance by health staff to community
d. Development of promotive, preventive, curative and rehabilitative care
e. Recognition of role and traditional healers in delivery of health services
 Community Participation
a. Awareness building and consciousness raising on health and developmental issues
b. Community building and organizing
c. Planning, implementation, monitoring and evaluation done by community
d. Community discussions done through small group discussions
e. Selection of community health workers by community
f. Foundation of health committees
g. Establishment of community health organizations
h. Mass health campaigns and community mobilization
 Self-reliance
a. Community generates support for health care
b. Mobilization of health resources
c. Training of community leaders on leadership and managerial skills
 d. Income-generating projects
 Recognition of interrelation of health and development
a. Convergence of health, food, nutrition, water, sanitation and population services
b. Integration of PHC into national, provincial, municipal and barangay
development plan
 Social Mobilization
a. Establishment of effective health referral system
b. Multi-sectoral and inter-disciplinary linkages
c. Integration, Education, Communication (IEC) support using multimedia channels
 Collaboration among government agencies, non-government organizations and
community groups
 Decentralization
a. Reallocation of budgetary resources
b. Advocacy for political will and support
c. Re-orientation of health profession
d. Establishment of community health organizations
e. Mass health campaigns and community mobilization
 Self-reliance
a. Community generates support for health care
b. Mobilization of health resources

D. Levels of Health Care and Levels of Prevention

The term “Health care delivery system” is often used to describe the way in which health
care is furnished to the people. Classification of health care delivery system is by acuity of
the client’s illnesses and level of specialization of the professionals.
 Primary care level
 Secondary care level
 Tertiary care level
Primary care level: is the usual entry point for clients of the health care delivery
system. It is oriented towards the promotion and maintenance of health, the prevention
of disease, the management of common episodic disease and the monitoring of stable or
chronic conditions. Primary care ordinarily occurs, in ambulatory settings. The client or
the family manages treatment with health professionals providing diagnostic expertise
and guidance.

Secondary care level: It involves the provision of specialized medical services by physician
or a hospital on a referral by the primary care provider. A patient has developed a
recognizable sign and symptoms that are either definitively diagnosed or require further
diagnosis. It is oriented towards clients with more severe acute illnesses or chronic illnesses
that are exacerbated. If hospitalization occurs it is usually in a community (district) hospital.
Most individuals who enter this level of care are referred by primary care worker, although
some are self-referred. The physicians who provide secondary care are usually specialists and
general practitioners.
Tertiary care level: It is a level of care that is specialized and highly technical in diagnosing
and treating complicated or unusually health problems. Patients requiring this level often
present in extensive and complicated pathological conditions. It is the most complex level of
care. The illness may be life-threatening, and the care ordinarily takes place in a major
hospital affiliated by a medical school. Clients are referred by workers from primary or
secondary settings. The health professionals, including physicians and nurses tend to be
highly specialized, and they focus on their area of specialization in the delivery of care.
The other classification of health care delivery system is:
Preventive: is aimed at stopping the disease process before it starts or preventing further
deterioration of a condition that already exists.
Curative: is aimed at restoring the client's health.
Rehabilitative: is aimed at lessening the pain and discomfort of illness and helping clients
live with disease and disability. Some nurse theorists have conceptualized the nursing role as
being focused on sustaining care and preventing disease. However, the work role of nurse
practitioners and home health care nurses would probably span all three of these orientations.
The nurse must understand and remember that the preventive services are also popularly
categorized as primary, secondary, and tertiary preventive health care.
Levels of prevention
Primary prevention: refers to the prevention of an illness before it has a chance to occur.
Aims
 Health promotion
 Protection against illness
Primary preventive measures apply before a disease manifests with sign and symptoms.
Examples:
 Eating well balanced diet
 Regular exercise program
 Maintaining weight
 No smoking
 Moderation of alcohol
 Information on alcohol substance
 Nutritional counseling
 Environmental control
 Safe water Supply
 Good food hygiene
 Safe waste management
 Vector and animal reservoir control
 Good living and working condition
 Stress management etc
Secondary prevention: includes the early detection of actual or potential health hazards.
This allows for prompt intervention and possibly a cure of a disease or condition. It is
directed forwards health maintenance for patients experiencing health problems.
Secondary prevention has two sub-levels
1. early detection (diagnosis) of disease
2. prompt treatment
e.g. hypertension screen and acute care.
Secondary prevention increases awareness of:
 breast self – examination
 testicular self-examination
 mammography
  pap smear
 BP screening
 Blood glucose screening
 Teaching breast self - examination
 Antibiotic treatment of streptococcal pharyngitis aimed at preventing rheumatic fever
 “Caution” of cancer
Tertiary Prevention: is aimed at avoiding further deterioration of an already existing
problem. Rehabilitative efforts are sometimes tertiary preventive measures. It deals with
rehabilitation and return of client to a status of maximum function within the limit posed by
the disease or disability and preventing further decline in health. This level of prevention
occurs after a disease caused extensive damage. 
Examples
 Rehabilitation after stroke
 Smoking cessation program for clients with
emphysema

E. UNIVERSAL HEALTH CARE -

Legal basis: RA 11223 Universal health Care Act – This is an Act instituting Universal
Health Care for all Filipinos prescribing Reforms in the Health Care System and
Appropriating Funds

8 Things to Know:
1. ALL Filipinos are covered
 Every single Filipino citizen is automatically enrolled into the newly-created National
Health Insurance Program (NHIP). The program classified membership into two types:
- Direct contributors – those who pay PhilHealth premiums, are employed and bound
by an "employer-employee relationship," self-earning, professional practitioners, and
migrant workers. Members’ qualified dependents and lifetime members are also
included.
- Indirect contributors – those not considered as direct contributors, along with their
qualified dependents, whose health premiums are subsidized by the government
 All Filipinos will be granted “immediate eligibility” and access to the full spectrum of
health care which includes preventive, promotive, curative, rehabilitative, and palliative
care. This can be expected for medical, dental, mental, and emergency health services.
 Filipinos will also be enrolled with a primary health care provider of their choice. The
primary care provider is the health worker they can go and seek treatment from for health
concerns. They will also serve as the person in charge of referring and coordinating with
other health centers if patients need further treatment.
 Citizens will not need to present any PhilHealth ID to avail of these benefits. Meanwhile,
poor Filipinos or those who are located in geographically isolated areas will also be given
priority when ensuring access to health services.
2. It is not completely free
  Contrary to what some people may think, UHC does not mean every single health
expense will be made free.
 The law outlines those basic services accommodations will be covered by PhilHealth.
 As a patient, that means that if you’re admitted in a hospital you can expect regular
meals, a bed in a shared room with fan ventilation, and a shared toilet and bath to be
covered.
 All are also entitled to an “essential health benefit package,” which includes primary
care, medicines, diagnostic, and laboratory tests. It also includes preventive, curative, and
rehabilitative services.
 It will no longer be free when one wants to stay in a hospital room offering private
accommodation, air conditioning, telephone, television, and meal choices, among others.
 Meanwhile, public and private hospitals are expected to allocate a certain portion of their
beds as basic accommodations in the following amounts:
- Government hospitals – at least 90% of beds
- Specialty hospitals – at least 70% of beds
- Private hospitals – at least 10% of beds
 As long as a patient avails of these basic accommodations, it will be covered by
PhilHealth whether in a public or private hospital.
 The law also states that if patients need to pay for extra expenses, their “co-payment” – or
what is paid on top of basic services – should be regulated by the DOH in public
hospitals. This means that you should know what to expect in terms of bills, as opposed
to being shocked after treatment.
Aside from this, current case rates or packages PhilHealth has crafted for certain diseases
will remain. But together with the DOH, PhilHealth is expected to work towards
including more
 needs a person may have for a disease in its case rates.
 The two agencies are also expected to craft and implement outpatient benefit services to
be covered by the National Health Insurance Programs within 2 years after the law takes
effect.
3. PhilHealth will become the “national purchaser” of health goods and services
 This means that PhilHealth will be in charge of paying health care providers like
hospitals and clinics for services given to Filipinos. This is already a job PhilHealth
carries out but the universal health care law wants to pool more funds so it can cover all
Filipinos and eventually, more services.
 Allocating more funds to PhilHealth will also strengthen its negotiating power with
health care providers, which will foreseeably improve the quality of services and lower
health costs.
 Funds for PhilHealth will be sourced from the following:
- Philippine Amusement and Gaming Corporation – 50% of national government’s
share
- Philippine Charity Sweepstakes Office (PCSO) – 40% of its charity fund, net of
document stamp tax payments, and mandatory PCSO contributions
- Premium contributions of direct contributory members
- PhilHealth annual budget
  With multiple fund sources for PhilHealth, Filipinos will no longer need to troop to
various government offices to secure funds to pay for health expenses. It will also make
them less dependent on politicians to help pay for health services.
 By giving PhilHealth more funds, a goal of the UHC is to make PhilHealth the national
purchaser of medicines. This can lower the cost of medicines as these will be bought in
bulk.
 Another goals is to have quality of health services improve as PhilHealth can set as a
requirement for payment and contracting, standards for health care providers.

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 entire populations.
 Think of these as programs for disease surveillance, health promotion campaigns, and
mass immunization campaigns.
 The 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 are tasked with managing
their own health centers.
 The DOH will need to work with the Department of the Interior and Local Government
(DILG) to have province- and city-wide health systems or networks in about two years
after the law takes affect.
 For this, one can imagine as an example, Rizal overseeing its province-wide health care
network of clinics and hospitals compared to each municipality in Rizal taking care of its
own health center alone. Similarly, highly urbanized cities like Cebu or Makati will
oversee their own health care network compared to single barangays being in charge of a
health center.
 Having access to health networks province-wide can address the problem of inadequate
access to health services due to lack of funds in barangays or municipalities.
 Provincial and city health boards will be in charge of pooling and managing a special
health fund to finance and improve health services for residents. PhilHealth’s income will
also be channeled to this special health fund.
6. Return service in the public health sector
 Graduates of health and health-related courses who received government-funded
scholarships will be required to work in the public health sector for at least 3 full
years. This will address the need for health workers across the country.
 They will be paid by and under the supervision of the DOH. Those who serve for an extra
two years will also be given incentives, which will be determined by the DOH.
 Meanwhile, graduates of health courses in state universities and colleges and private
schools are encouraged to work in the public sector.
7. A “Health Technology and Assessment Council” (HTAC) will be created
 Another important feature of the law is the creation of the HTAC – a group of health
experts who will be responsible for evaluating latest health developments and
recommending their use to DOH and PhilHealth.
  The HTAC will be responsible for assessing the safety and effectiveness of health
technology, devices, medicines, vaccines, health procedures, and other health-related
advances developed to solve health problems.
 Reviewing the social, economic, and ethical issues when using these technologies or
programs is also required.
 The HTAC will be attached to the DOH for the first 5 years after the law is implemented.
After this, it will become an independent body attached to the Department of Science and
Technology.

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.”
This system will be developed and funded by DOH and PhilHealth. It will also be
subject to patient confidentiality rules and data privacy laws.