Far Eastern University

Institute of Nursing
SY 2022-2023

Community Health Nursing 1 (Family and Individual)

The Philippine Health Care Delivery System, National Objectives for Health, DOH Programmes

LEARNING OUTCOMES

At the end of the module, the learner will be able to:

1. Discuss what is a health system and its building blocks.

2. Describe the Philippine Health Care Delivery System.
3. Explain the bases and major strategic thrusts of the National Objectives for Health, 2017-
2022.
4. Discuss the various health programs of the Department of Health.

MODULE OUTLINE

I. Introduction
II. Definition of a health system and its building blocks
III. The Philippine Health Care Delivery System
IV. The National Objectives for Health, 2017-2022
V. Assessment

I. Introduction

Family nursing practice entails that the nurse appreciates the context in which she
carries out her role as care provider to families as she is an important part of the health system.
This module focuses on a broad description of what a health system is. Specifically, it also deals
with a detailed description of the Philippine health care delivery system. The National
Objectives for Health is also being presented in this module. Last but not least, are the
important DOH programs that a nurse should fully understand. This will allow full
comprehension of one’s role within the perspective of these programs.

II. Definition of a health system

A health system consists of all the organizations, institutions, resources and people
whose primary purpose is to improve health.
 This includes efforts to influence determinants of health as well as more direct health-
improvement activities. The health system delivers preventive, promotive, curative and
rehabilitative interventions through a combination of public health actions and the pyramid of
health care facilities that deliver personal health care — by both State and non-State actors.

A health system needs staff, funds, information, supplies, transport, communications

and overall guidance and direction to function.

The building blocks of a health system are as follows:

1. Service delivery
2. Health workforce
3. Health information systems
4. Access to essential medicines
5. Financing
6. Leadership/governance

III. The Philippine Health Care Delivery System

The Philippine health system is characterized as a dual health system composed of the
public sector and the private sector. The public sector is largely financed through a tax-based
budgeting system, where health services are delivered by government facilities run by the
National and local governments. The private sector, consisting of for-profit and nonprofit health-
care providers, is largely market-oriented where health care is generally paid for through user
fees at the point of service (Department of Health, 2005).

Health as a basic human right is enshrined in the 1987 Philippine Constitution (Article II,
Section 15), which declares “the State shall protect and promote the right to health of the
people and instill health consciousness among them”. Under this mandate, the DOH, as the
national technical authority on health, has the responsibility to ensure the highest achievable
standards of health care, from which Local Government Units (LGUs), Non-Government
Organizations (NGOs), the private sector and other stakeholders anchor their health
programmes and strategies (Office of the President of the Philippines, 1999).

The pillars of the health system are health service delivery, health financing, health
governance and regulation.

1. Health Service Delivery

The Public Sector. Both the national government and LGUs manage the delivery of
promotive, preventive, curative and rehabilitative health services. The DOH supervises the
government corporate hospitals, specialty and regional hospitals while the Department of
National Defense (DND) runs the military hospitals. Both agencies provide tertiary care. At
the local level, the provincial governments manage district and provincial hospitals.
Meanwhile, municipal governments provide primary care including preventive and
promotive health services and other public health programs through the RHUs, health
centers and BHSs, which are the first point of contact for government-provided health
services, (Dayrit, et al., 2018).

The Private Sector. The private sector caters to only about 30 percent of the population but
is far larger than the public system in terms of financial resources and staff (Oxford Business
Group, 2018). It provides healthcare that is generally paid through user fees at point of
service. About 65 percent of the 1,224 hospitals in the country in 2016 were private (DOH-
HFSRB, 2016). The private sector is extensive but fragmented, with thousands of for profit
and non-profit providers involved in the delivery of health-care services. The private sector
consists of clinics, infirmaries, laboratories, hospitals, drugstores, pharmaceutical and
medical supply companies, health insurance companies, academic and research institutions
involved in health and other service providers that include traditional healers (herbolarios)
and traditional birth attendants (hilots). For-profit health enterprises are largely run by self-
employed health professionals, family-owned businesses and corporate entities, while non-
profit health enterprises are commonly run by charitable institutions, faith-based
organizations, civil society organizations (CSOs) and community-based volunteer groups.
Their collective contribution to health is enormous and their capacity augments the gaps in
and inadequacies of the public sector.

2. Health Financing

The National Health Insurance Act of 1995 created the Philippine Health
Insurance Corporation (PhilHealth) to provide health insurance coverage for all Filipinos
but enrolment was not made compulsory. In 2013, it was amended, expanding the
contribution based national health insurance program (NHIP) beyond formal
employment to include the underprivileged, sick, elderly, persons with disabilities
(PWDs) and women and children. It strengthened the roles of the LGUs and health
providers in NHIP enrolment. PhilHealth serves as the national social health insurance
agency which purchases services from public and private providers on behalf of its
members. However, healthcare provision, health regulation, facility improvements and
human resource deployment as well as capacitation are still subsidized by the
government, mainly through the DOH. Government budget also flows through the
health contributions of other central institutions such as DND, the Philippine National
Police (PNP), the University of the Philippines (all of which manage large hospitals), the
Philippine Charity Sweepstakes Office (PCSO), and the Philippine Amusement and
Gaming Corporation (PAGCOR). PhilHealth administers the National Health Insurance
Program (NHIP) to provide all Filipinos with financial risk protection. The government
fully subsidizes the PhilHealth premiums of the poor identified through the National
Household Targeting Survey for Poverty Reduction (NHTS-PR).
 3. Health Governance and Regulation

The DOH acts as the national lead agency in health. The DOH central office consists
of 18 bureaus and services responsible for policy development, programme planning,
standards setting and regulation, and related management support services. To provide
technical assistance to LGUs and monitor field operations, the DOH has 17 regional
health offices, one for each of the 17 administrative regions of the country. It also
manages and operates several regional hospitals, medical centres, sanitaria, treatment
and rehabilitation centres, and special hospitals that provide tertiary specialized health
services and specialty training to health professionals. Attached to the DOH are several
autonomous agencies such as the National Nutrition Council (NNC) and the Population
Commission, and corporate entities such as PhilHealth, the Philippine Institute of
Traditional and Alternative Health Care, and four highly specialized corporate hospitals.

The local government in the Philippines consists of 81 provinces, 145 cities (of which
33 are highly urbanized cities and five are independent component cities), 1489
municipalities and 42 025 barangays (Philippine Statistics Authority, 2015).

With the devolution of health services under the Local Government Code of 1991,
the direct provision and management of health services such as public health
programmes, promotive and preventive health care, and primary and secondary general
hospital services were transferred to LGUs. Under this set-up, the provincial
government, headed by the governor, manages the provincial health system
(comprising the provincial health office and the provincial and district hospitals). The
municipal government, headed by the mayor, manages the municipal health system
(composed of RHUs and BHSs). The city government, specifically in highly urbanized and
independent cities, manages city hospitals, medical centres, health centres and BHSs. In
every province, city or municipality, there is a local health board chaired by the local
chief executive. Its function is to serve as an advisory body to the local chief executive
and the local legislative council (sanggunian) on health-related matters. Under the Local
Government Code of 1991, the DOH maintains representation in all local health boards
through the DOH representatives (organized most recently as Development
Management Officers under the DOH Provincial Health Teams).

IV. The National Objectives for Health

What is the National Objectives for Health?

The National Objectives for Health (NOH) 2017–2022 serves as the medium-term
roadmap of the Philippines towards achieving universal healthcare (UHC).

It specifies the objectives, strategies and targets of the Department of Health (DOH)
FOURmula One Plus for Health (F1 Plus for Health) built along the health system pillars of
financing, service delivery, regulation, governance and performance accountability.

What is the purpose of the National Objectives for Health:

 Through this document, the DOH hopes to ensure uniform understanding of the F1 Plus
for Health and guide agencies, local government units (LGUs) and other stakeholders in
translating medium-term health policy directions, strategies and benchmarks into concrete
programs and projects that will allow all Filipinos, especially the poor, to readily access and use
aff ordable quality care, and thereby boosting universal healthcare.

What are the three major goals that the Philippine Health Agenda?

1. Better health outcomes with no major disparity among population groups;

2. Financial risk protection for all especially the poor, marginalized and vulnerable;
and
3. A responsive health system which makes Filipinos feel respected, valued and
empowered.

What are the latest health trends?

Summary of Selected Health Outcomes in the Philippines (National Objectives for Health, 2017)

Note: Adapted from the National objectives for health Philippines 2017-2022 by The Department of Health, 2018, p.9, Manila, Philippines: Department of Health.
Ten Leading Causes of Mortality in the Philippines, 201

Note: Adapted from the National objectives for health Philippines 2017-2022 by The Department of Health, 2018, p.11, Manila, Philippines: Department of Health.

Ten Leading Causes of Morbidity in the Philippines, 2016

Note: Adapted from the National objectives for health Philippines 2017-2022 by The Department of Health, 2018, p.12, Manila, Philippines: Department of Health.

What is the health status of the Philippines?

 Despite living longer than in previous years, Filipinos now bear

a triple burden of disease with the high prevalence of
communicable diseases and NCDs.
 Filipinos are also susceptible to risks brought by the increasing
impact of globalization and climate change, with the Philippines
ranking third in the world in terms of exposure to disaster risks
(Dayrit et al., 2018).
 Thousands have died from previous rapid onset disasters that
struck the country, commonly owing to trauma, drowning or
crush-related injuries. Moreover, flooding can increase
transmission of certain diseases such as leptospirosis and
dengue, while power cuts may disrupt water treatment and
supply, exposing the population to the risk of water-borne
diseases (WHO, 2018).
What are the challenges and implications of the current health status of the country?

 Mixed health outcomes

The country only had modest gains in selected health outcome indicators and weak
performance in others. These were not enough to realize the country’s targets in the
NOH 2011-2016 and the Millennium Development Goals (MDGs). Availability,
accessibility and affordability of quality healthcare have impeded healthcare utilization.
The archipelagic nature of the country, uneven distribution of its population and the
varying levels of economic growth in the regions led to human resource for health
maldistribution, with health workers, particularly doctors and nurses, concentrated in
more urbanized and economically developed areas.

 Disjointed health system

Overlapping and sometimes, conflicting mandates of the DOH and LGUs on health owing
to devolution led to the disintegration of the originally integrated referral system that
linked public health services and hospital services.

 High out of the pocket expenditures

More than half of health expenditures remained to be funded by out-of-pocket (OOP)

payments despite increased resources for health in recent years.

What is the response of government to these challenges and implications?

In response to the challenges identified in improving health outcomes and the health
system, the DOH pursues FOURmula One Plus (F1 Plus) for Health, which aims to provide
Universal Health Care (UHC) for all Filipinos in the medium to long term. The national policy on
UHC espouses three strategic thrusts: better health outcomes, responsive health system, and
equitable and sustainable health financing.
 Note: Adapted from the National objectives for health Philippines 2017-2022 by The Department of Health, 2018, p.15, Manila, Philippines: Department of Health.

Note: Adapted from the National objectives for health Philippines 2017-2022 by The Department of Health, 2018, p.16, Manila, Philippines: Department of Health.
 F1 Plus for Health builds on the previous policy on F1 for Health initiated by the DOH in
2005-2010, and the Philippine Health Agenda 2016-2022, which was committed to bringing “All
for Health Towards Health for All”.

This medium-term strategic framework for health supports the following:

 Philippine Development Plan (PDP) 2017-2022: Malasakit, Pagbabago at Patuloy na Pag-

unlad (enhancing the social fabric, inequality-reducing transformation and increasing
growth potential)
 Ambisyon Natin 2040: Matatag, Maginhawa at Panatag na Buhay – the long-term vision
of the country, which sees Filipinos as having strongly rooted, prosperous and secure
lives.

V. DOH Programmes

NATIONAL SAFE MOTHERHOOD PROGRAM

Vision
For Filipino women to have full access to health services towards making their pregnancy and
delivery safer.

Mission
Guided by the Department of Health FOURmula One Plus thrust and the Universal Health Care
Frame, the National Safe Motherhood Program is committed to provide rational and responsive
policy direction to its local government partners in the delivery of quality maternal and newborn
health services with integrity and accountability using proven and innovative approaches

Objectives
The Program contributes to the national goal of improving women’s health and well-being by:
1. Collaborating with Local Government Units in establishing sustainable, cost-effective approach
of delivering health services that ensure access of disadvantaged women to acceptable and high
quality maternal and newborn health services and enable them to safely give birth in health
facilities near their homes
2. Establishing core knowledge base and support systems that facilitate the delivery of quality
maternal and newborn health services in the country.

Program Components
Component A: Local Delivery of the Maternal–Newborn Service Package
This component supports LGUs in establishing and mobilizing the service delivery network of
public and private providers to enable them to deliver the integrated maternal-newborn service
package. In each province and city, the following shall continue to be undertaken:
1. Establishment of critical capacities to provide quality maternal-newborn services through the
organization and operation of a network of Service Delivery Teams consisting of:
a. Barangay Health Workers
 b. BEmONC Teams composed of Doctors, Nurses and Midwives
2. In collaboration with the Centers for health Development and relevant national offices:
Establishment of Reliable Sustainable Support Systems for Maternal-Newborn Service Delivery
through such initiatives as:
a. Establishment of Safe Blood Supply Network with support from the National Voluntary
Blood Program
b. Behavior Change Interventions in collaboration with the Health Promotion and
Communication Service
c. Sustainable financing of maternal - newborn services and commodities through locally
initiated revenue generation and retention activities including PhilHealth accreditation
and enrolment.
Component B: National Capacity to Sustain Maternal-Newborn Services
1. Operational and Regulatory Guidelines
a. Identification and profiling of current FP users and identification of potential FP clients
and those with unmet need for FP (permanent or temporary methods)
b. Mainstreaming FP in the regions with high unmet need for FP
c. Development and dissemination of Information, Education Communication materials
d. Advocacy and social mobilization for FP
2. Network of Training Providers
a. 31 Training Centers that provide BEmONC Skills Training
3. Monitoring, Evaluation, Research, and Dissemination with support from the Epidemiology
Bureau and Health Policy Development and Planning Bureau
a. Monitoring and Supervision of Private Midwife Clinics in cooperation with PRC Board of
Midwifery and Professional Midwifery Organizations
b. Maternal Death Reporting and Review System in collaboration with Provincial and City
Review Teams
c. Annual Program Implementation Reviews with Provincial Health Officers and Regional
Coordinators

Maternal, Neonatal and Child Health and Nutrition (MNCHN) Service Delivery Network refers to
the network of facilities and providers within a province and (chartered) city health system
offering integrated MNCHN services in a coordinated manner, including the supporting
financing, communication and transportation systems. Such network includes the BEmONC-
CEmONC network (a network of facilities providing emergency obstetric and newborn care) and
matches the Inter-Local Health Zone (ILHZ) arrangement.

*Basic Emergency Obstetrics and Newborn Care (BEmONC) Provider is a capable private health
facility or an appropriately upgraded public health facility that is either a Rural Health Unit (RHU)
and/or its satellite Barangay Health Station (BHS) or Hospital capable of performing the
following emergency obstetric functions: (1) parenteral administration of oxytocin in the third
stage of labor; (2) parenteral administration of loading dose of anti-convulsants; (3) parenteral
administration of initial dose of antibiotics; (4) performance of assisted deliveries in imminent
breech; (5) removal of retained placental products ; and (6) manual removal of retained
placenta. It is also capable of providing neonatal emergency interventions, which include at the
minimum, newborn resuscitation, provision of warmth, and referral. The hospital BEmONC shall
also be capable of providing blood transfusion services. These facilities can likewise serve as high
volume providers for IUD (intra-uterine device) and VSC (voluntary surgical contraception)
services. It can also be a single or stand alone facility or part of a network of facilities in an inter-
local health zone.

Comprehensive Emergency Obstetrics and Newborn Care (CEmONC) Provider is a tertiary level
regional hospital or medical center, provincial hospital or an appropriately upgraded district
hospital. It can also be a capable privately operated medical center. It is capable of performing
emergency obstetric functions as in BEmONC provider facilities, as well as provides surgical
delivery (caesarean section) and blood bank transfusion services, and other highly specialized
obstetric interventions. It is also able to provide emergency neonatal care, which include the
minimum: (1) newborn resuscitation; (2) treatment of neonatal sepsis/infection; (3) oxygen
support; and, (4) antenatal administration of (maternal) steroids for threatened premature
delivery. It can also serve as high volume providers for intra-uterine device (IUD) and voluntary
surgical contraception (VSC) services.

Policies and Laws

Republic Act No. 10354: Responsible Parenthood and Reproductive Health Law (RPRH Act of
2012)

UNANG YAKAP (ESSENTIAL NEWBORN CARE: PROTOCOL FOR NEW LIFE)

Many initiatives, globally and locally, help save lives of pregnant women and
children. Essential Newborn Care (ENC) is one.

ENC is a simple cost-effective newborn care intervention that can improve neonatal as
well as maternal care. IT is an evidence-based intervention that emphasizes a core sequence of
actions, performed methodically (step -by-step); is organized so that essential time bound
interventions are not interrupted; and fills a gap for a package of bundled interventions in a
guideline format.

NEWBORN SCREENING PROGRAM

Description
The Comprehensive Newborn Screening (NBS) Program was integrated as part of the
country’s public health delivery system with the enactment of the Republic Act no. 9288
otherwise known as Newborn Screening Act of 2004. The Department of Health (DOH) acts as
the lead agency in the implementation of the law and collaborates with other National
Government Agencies (NGA) and key stakeholders to ensure early detection and management
of several congenital metabolic disorders, which if left untreated, may lead to mental
retardation and/or death. Early diagnosis and initiation of treatment, along with appropriate
long-term care help ensure normal growth and development of the affected individual. It has
been an integral part of routine newborn care in most developed countries for five decades,
either as a health directive or mandated by law. It is also a service that has been available in the
Philippines since 1996. Under the DOH, NBS is part of the Child Development and Disability
Prevention Program at the Disease Prevention and Control Bureau.

Vision
The National Comprehensive Newborn Screening System envisions all Filipino children will be
born healthy and well, with an inherent right to life, endowed with human dignity; and Reaching
their full potential with the right opportunities and accessible resources

Mission
To ensure that all Filipino children will have access to and avail of total quality care for the
optimal growth and development of their full potential.

Goal
To reduce preventable deaths of all Filipino newborns due to more common and rare congenital
disorders through timely screening and proper management

EXPANDED PROGRAM ON IMMUNIZATION

Rationale
The Expanded Program on Immunization (EPI) was established in 1976 to ensure that
infants/children and mothers have access to routinely recommended infant/childhood vaccines.
Six vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis and measles. In 1986, 21.3% “fully immunized” children less than
fourteen months of age based on the EPI Comprehensive Program review.

In 2002, WHO estimated that 1.4 million of deaths among children under 5 years due to
diseases that could have been prevented by routine vaccination. This represents 14% of global
total mortality in children under 5 years of age.

Goal:
To reduce the morbidity and mortality among children against the most common
vaccine-preventable diseases.

Objectives:
1. To immunize all infants/children against the most common vaccine-preventable diseases.
2. To sustain the polio-free status of the Philippines.
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus
5. To control diphtheria, pertussis, hepatitis b and German measles.
6. To prevent extra pulmonary tuberculosis among children.

Mandates:
 Republic Act No. 10152“MandatoryInfants and Children Health Immunization Act of
2011Signed by President Benigno Aquino III in July 26, 2010. The mandatory includes basic
immunization for children under 5 including other types that will be determined by the
Secretary of Health.

Strategies:
 Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every
Barangay (REB) strategy
REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was
introduced in 2004 aimed to improve the access to routine immunization and reduce drop-
outs. There are 5 components of the strategy, namely: data analysis for action, re-establish
outreach services, , strengthen links between the community and service, supportive
supervision and maximizing resources.

 Supplemental Immunization Activity (SIA)

Supplementary immunization activities are used to reach children who have not been
vaccinated or have not developed sufficient immunity after previous vaccinations. It can be
conducted either national or sub-national –in selected areas.

 Strengthening Vaccine-Preventable Diseases Surveillance

This is critical for the eradication/elimination efforts, especially in identifying true cases of
measles and indigenous wild polio virus.

 Procurement of adequate and potent vaccines and needles and syringes to all health facilities
nationwide.

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

One million children under five years old die each year in less developed countries. Just
five diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic fever) account
for nearly half of these deaths and malnutrition is often the underlying condition. Effective and
affordable interventions to address these common conditions exist but they do not yet reach
the populations most in need, the young and impoverish.

The Integrated Management of Childhood Illness strategy has been introduced in an

increasing number of countries in the region since 1995. IMCI is a major strategy for child
survival, healthy growth and development and is based on the combined delivery of essential
interventions at community, health facility and health systems levels. IMCI includes elements of
prevention as well as curative and addresses the most common conditions that affect young
children. The strategy was developed by the World Health Organization (WHO) and United
Nations Children’s Fund (UNICEF).
In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health
workers and hospital staff were capacitated to implement the strategy at the frontline level.
 Objectives of IMCI
 Reduce death and frequency and severity of illness and disability, and
 Contribute to improved growth and development

Components of IMCI
 Improving case management skills of health workers
11-day Basic Course for RHMs, PHNs and MOHs
5 - day Facilitators course
5 – day Follow-up course for IMCI Supervisors
 Improving over-all health systems
 Improving family and community health practices

Rationale for an integrated approach in the management of sick children

Majority of these deaths are caused by 5 preventable and treatable conditions
namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out of four
(4) episodes of childhood illness are caused by these five conditions
Most children have more than one illness at one time. This overlap means that a single
diagnosis may not be possible or appropriate.

Who are the children covered by the IMCI protocol?

Sick children birth up to 2 months (Sick Young Infant)
Sick children 2 months up to 5 years old (Sick child)

Strategies/Principles of IMCI
 All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs and all
Sick Young Infants Birth up to 2 months are examined for VERY SEVERE DISEASE AND LOCAL
BACTERIAL INFECTION. These signs indicate immediate referral or admission to hospital
 The children and infants are then assessed for main symptoms. For sick children, the main
symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For sick
young infants, local bacterial infection, diarrhea and jaundice. All sick children are routinely
assessed for nutritional, immunization and deworming status and for other problems
 Only a limited number of clinical signs are used
 A combination of individual signs leads to a child’s classification within one or more symptom
groups rather than a diagnosis.
 IMCI management procedures use limited number of essential drugs and encourage active
participation of caretakers in the treatment of children
 Counseling of caretakers on home care, correct feeding and giving of fluids, and when to return
to clinic is an essential component of IMCI
 LIFESTYLE-RELATED DISEASES

Description
Non-communicable diseases (NCDs) include cardiovascular conditions (hypertension, stroke),
diabetes mellitus, lung/chronic respiratory diseases and a range of cancers which are the top
causes of deaths globally and locally. These diseases are considered as lifestyle related and is
mostly the result of unhealthy habits. Behavioral and modifiable risk factors like smoking,
alcohol abuse, consuming too much fat, salt and sugar and physical inactivity have sparked an
epidemic of these NCDs which pose a public threat and economic burden.

Vision
A Philippines free from the avoidable burden of NCDs

Mission
Ensure sustainable health promoting environments and accessible, cost-effective,
comprehensive, equitable and quality health care services for the prevention and control of
NCDs, and guided by the principle of “Health in All, Health by All, Health for All” whereas Health
in All refers to Health in All Policies, Health by All involves the whole-of-government and the
whole-of-society and the Health for All captures the KP (Kalusugan Pangkalahatan) or the
Universal Health Care (UHC).

Objectives
1. To raise the priority accorded to the prevention and control of non-communicable diseases
in national, regional and local health and development plans
2. To strengthen leadership, governance, and multisectoral actions for the prevention and
control of non-communicable diseases
3. To reduce modifiable risk factors for non-communicable diseases and underlying social
determinants through creation of health-promoting environments
4. To strengthen health systems and increase access to quality medicines, products and
services, especially at the primary health care level, towards attainment of universal health
coverage
5. To promote and support research and development for the prevention and control of non-
communicable diseases
6. To monitor the trends and determinants of non-communicable diseases and evaluate
progress in their prevention and control.

Program Components
1. Cardiovascular Disease
2. Diabetes Mellitus
3. Cancer
4. Chronic Respiratory Disease

Conceptual Framework
Administrative Order-2011-0003 National Policy On Strengthening the Prevention and Control of
Chronic Lifestyle Related Non-Communicable Diseases

NATIONAL FAMILY PLANNING PROGRAM

Vision
For Filipino women and men achieve their desired family size and fulfill the reproductive health
and rights for all through universal access to quality family planning information and services.

Mission
In line with the Department of Health FOURmula One Plus strategy and Universal Health Care
framework, the National Family Planning Program is committed to provide responsive policy
direction and ensure access of Filipinos to medically safe, legal, non-abortifacient, effective, and
culturally acceptable modern family planning (FP) methods.

Objectives
1. To increase modern Contraceptive Prevalence Rate (mCPR) among all women from 24.9% in
2017 to 30% by 2022
2. To reduce the unmet need for modern family planning from 10.8% in 2017 to 8% by 2022

Program Components

Component A: Provision of free FP Commodities that are medically safe, legal, non-
abortifacient, effective and culturally acceptable to all in need of the FP service:

 Forecasting of FP commodity requirements for the country

 Procurement of FP commodities and its ancillary supplies
 Strengthening of the supply chain management in FP and ensuring of adequate FP
supply at the service delivery points

Component B: Demand Generation through Community-based Management Information

System:

 Identification and profiling of current FP users and identification of potential FP clients

and those with unmet need for FP (permanent or temporary methods)
 Mainstreaming FP in the regions with high unmet need for FP
 Development and dissemination of Information, Education Communication materials
 Advocacy and social mobilization for FP

Component C: Family Planning in Hospitals and other Health Facilities

 Establishment of FP service package in hospitals

 Organization of FP Itinerant team for outreach missions
  Delivery of FP services by hospitals to the poor communities especially Geographically
Isolated and Disadvantaged Areas (GIDAs):
 Provision of budget support to operations by the itinerant teams including logistics and
medical supplies needed for voluntary surgical sterilization services
 FP services as part of medical and surgical missions of the hospital
 Partnership with LGU hospitals for the FP outreach missions
o Component D: Financial Security in FP
 Strengthening PhilHealth benefit packages for F
 Expansion of PhilHealth coverage to include health centers providing No Scalpel
Vasectomy and FP Itinerant Teams
 Expansion of Philhealth benefit package to include pills, injectables and IUD
 Social Marketing of contraceptives and FP services by the partner NGOs
 National Funding/Subsidy

Policies and Laws

1. Republic Act No. 10354: Responsible Parenthood and Reproductive Health Act of 2012 (RPRH
Law)
2. Executive Order No. 12, s. 2017: Attaining and Sustaining “Zero Unmet Need for Modern Family
Planning” Through the Strict Implementation of the Responsible Parenthood and Reproductive
Health Act, Providing Funds Therefor, and for other Purposes

Strategies, Action Points and Timeline

Apart from the routine means of FP service delivery, the National Family Planning Program also
employs the following main strategies to ensure universal access to FP:
1. FP Outreach Mission – this maximizes opportunities where clients are and FP services are
delivered down to the community level.
2. FP in hospitals – this address missed opportunities where women especially those who
recently gave birth are offered with appropriate FP services.
3. Intensive Demand generation through house-to-house visits by the community health
volunteers, Family Development Sessions, Usapan sessions, among others

NATIONAL TUBERCULOSIS TB CONTROL PROGRAM

I. Vision
TB -free Philippines
II. Mission
 To reduce TB burden (TB incidence and TB mortality)
 To achieve catastrophic cost of TB-affected households
 To responsively deliver TB service
III. Program Components
 Health Promotion
 Financing and Policy
 Human Resource
 Information System
 Regulation
 Service Delivery
 Governance
IV. Target Population / Client
Presumptive TB and TB affected households

V. Area of Coverage
Nationwide
VII. Policies and Laws
RA 10767 : Comprehensive TB Elimination Plan Act of 2016

VIII. Strategies, Action Points and Timeline

2017-2022 Philippine Strategic TB Elimination Plan
 Activate communities and patient groups to promptly access quality TB services
 Collaborate with other government agencies to reduce out-of-pocket expenses and expand
social protection programs
 Harmonize local and national efforts mobilize adequate and competent human resources
 Innovate TB information generation and utilization for decision making
 Enforce standards on TB care and prevention and use of quality products
 Value clients and patients through integrated patient-centered TB services
 Engage national, regional and local government units/ agencies on multi-sectoral
implementation of TB elimination plan

SMOKING CESSATION PROGRAM

Rationale:
The use of tobacco continues to be a major cause of health problems worldwide. There is
currently an estimated 1.3 billion smokers in the world, with 4.9 million people dying because of
tobacco use in a year. If this trend continues, the number of deaths will increase to 10 million
by the year 2020, 70% of which will be coming from countries like the Philippines. (The Role of
Health Professionals in Tobacco Control, WHO, 2005)

The World Health Organization released a document in 2003 entitled Policy Recommendations
for Smoking Cessation and Treatment of Tobacco Dependence. This document very clearly
stated that as current statistics indicate, it will not be possible to reduce tobacco related deaths
over the next 30-50 years unless adult smokers are encouraged to quit. Also, because of the
addictiveness of tobacco products, many tobacco users will need support in quitting. Population
survey reports showed that approximately one third of smokers attempt to quit each year and
that majority of these attempts are undertaken without help. However, only a small percentage
of cigarette smokers (1-3%) achieve lasting abstinence, which is at least 12 months of abstinence
from smoking, using will power alone (Fiore et al 2000) as cited by the above policy paper.

The policy paper also stated that support for smoking cessation or “treatment of tobacco
dependence” refers to a range of techniques including motivation, advise and guidance,
counseling, telephone and internet support, and appropriate pharmaceutical aids all of which
aim to encourage and help tobacco users to stop using tobacco and to avoid subsequent
relapse. Evidence has shown that cessation is the only intervention with the potential to reduce
tobacco-related mortality in the short and medium term and therefore should be part of an
overall comprehensive tobacco-control policy of any country.

The Philippine Global Adult Tobacco Survey conducted in 2009 (DOH, Philippines GATS Country
Report, March 16, 2010) revealed that 28.3% (17.3 million) of the population aged 15 years old
and over currently smoke tobacco, 47.7% (14.6 million) of whom are men, while 9.0% (2.8
million) are women. Eighty percent of these current smokers are daily smokers with men and
women smoking an average of 11.3 and 7 sticks of cigarettes per day respectively.

The survey also revealed that among ever daily smokers, 21.5% have quit smoking. Among
those who smoked in the last 12 months, 47.8% made a quit attempt, 12.3% stated they used
counseling and or advise as their cessation method, but only 4.5% successfully quit. Among
current cigarette smokers, 60.6% stated they are interested in quitting, translating to around 10
million Filipinos needing help to quit smoking as of the moment. The above scenario dictates the
great need to build the capacity of health workers to help smokers quit smoking, thus the need
for the Department of Health to set up a national infrastructure to help smokers quit smoking.

The national smoking infrastructure is mandated by the Tobacco Regulations Act which orders
the Department of Health to set up withdrawal clinics. As such DOH Administrative Order No.
122 s. 2003 titled The Smoking Cessation Program to support the National Tobacco Control and
Healthy Lifestyle Program allowed the setting up of the National Smoking Cessation Program.

Vision: Reduced prevalence of smoking and minimizing smoking-related health risks.

Mission: To establish a national smoking cessation program (NSCP).

Objectives:

The program aims to:

1. Promote and advocate smoking cessation in the Philippines; and

2. Provide smoking cessation services to current smokers interested in quitting the habit.

Program Components:

The NSCP shall have the following components:

1. Training

The NSCP training committee shall define, review, and regularly recommend training programs
that are consistent with the good clinical practices approved by specialty associations and the in
line with the rules and regulations of the DOH.

All DOH health personnel, local government units (LGUs), selected schools, industrial and other
government health practitioners must be trained on the policies and guidelines on smoking
cessation.

2. Advocacy

A smoke-free environment (SFE) shall be maintained in DOH and participating non-DOH

facilities, offices, attached agencies, and retained hospitals. DOH officials, staff, and employees,
together with the officials of participating non-DOH offices, shall participate in the observance
and celebration of the World No Tobacco Day (WNTD) every 31st of May and the World No
Tobacco Month every June.

3. Health Education

Through health education, smokers shall be assisted to quit their habit and their immediate
family members shall be empowered to assist and facilitate the smoking cessation process.

4. Smoking Cessation Services

Below is the National Smoking Cessation Framework detailing Smoking Cessation services at
different levels of care

5. Research and Development

Research and development activities are to be conducted to better understand the nature of
nicotine dependence among Filipinos and to undertake new pharmacological approaches.

HIV/STI PREVENTION PROGRAM

Objective:
Reduce the transmission of HIV and STI among the Most At Risk Population and General
Population and mitigate its impact at the individual, family, and community level.

Program Activities:
With regard to the prevention and fight against stigma and discrimination, the following are the
strategies and interventions:
1. Availability of free voluntary HIV Counseling and Testing Service;
2. 100% Condom Use Program (CUP) especially for entertainment establishments;
 3. Peer education and outreach;
4. Multi-sectoral coordination through Philippine National AIDS Council (PNAC);
5. Empowerment of communities;
6. Community assemblies and for a to reduce stigma;
7. Augmentation of resources of social Hygiene Clinics; and
8. Procured male condoms distributed as education materials during outreach.

MENTAL HEALTH PROGRAM

Description
Mental health and well-being is a concern of all. Addressing concerns related to MNS
contributes to the attainment of the SDGs. Through a comprehensive mental health program
that includes a wide range of promotive, preventive, treatment and rehabilitative services; that
is for all individuals across the life course especially those at risk of and suffering from MNS
disorders; integrated in various treatment settings from community to facility that is
implemented from the national to the barangay level; and backed with institutional support
mechanisms from different government agencies and CSOs, we hope to attain the highest
possible level of health for the nation because there is no Universal Health Care without mental
health
Vision
A society that promotes the well-being of all Filipinos, supported by transformative multi-
sectoral partnerships, comprehensive mental health policies and programs, and a responsive
service delivery network
Mission
To promote over-all wellness of all Filipinos, prevent mental, psychosocial, and neurologic
disorders, substance abuse and other forms of addiction, and reduce burden of disease by
improving access to quality care and recovery in order to attain the highest possible level of
health to participate fully in society.
Objectives
1. To promote participatory governance and leadership in mental health
2. To strengthen coverage of mental health services through multi-sectoral partnership to provide
high quality service aiming at best patient experience in a responsive service delivery network
3. To harness capacities of LGUs and organized groups to implement promotive and preventive
interventions on mental health
4. To leverage quality data and research evidence for mental health
5. To set standards for compliance in different aspects of services
Program Components
1. Wellness of Daily Living
 All health/social/poverty reduction/safety and security programs and the like are protective
factors in general for the entire population
 Promotion of Healthy Lifestyle, Prevention and Control of Diseases, Family wellness programs,
etc
 School and workplace health and wellness programs
2. Extreme Life Experience
 Provision of mental health and psychosocial support (MHPSS) during personal and community
wide disasters
3. Mental Disorder
4. Neurologic Disorders
5. Substance Abuse and other Forms of Addiction
 Provision of services for mental, neurologic and substance use disorders at the primary level
from assessment, treatment and management to referral; and provision of psychotropic drugs
which are provided for free.
 Enhancement of mental health facilities under HFEP

EMERGING AND RE-EMERGING INFECTIOUS DISEASE PROGRAM

Description
In the recent past, the Philippines has seen many outbreaks of emerging infectious diseases and
it continues to be susceptible to the threat of re-emerging infections such as leptospirosis,
dengue, meningococcemia, tuberculosis among. The current situation emphasizes the risks and
highlights the need to improve preparedness at local, national and international levels for
against future pandemics. New pathogens will continue to emerge and spread across regions
and will challenge public health as never before signifying grim repercussions and health
burden. These may cause countless morbidities and mortalities, disrupting trade and negatively
affect the economy.

There are several social determinants contributing to the emergence of novel infectious
diseases and resurgence of controlled or eradicated infectious diseases in our country. These
contributing factors are namely: (1) Demographic factors like the population distribution and
density, (2) international travel/ tourism and increased OFWs, (3) Socio-economic factors and (4)
Environmental factors. The latter includes our country’s vulnerability to disasters, increased
livestock production, man- made ecological changes or industries and lastly the urbanization
which encroach and destroy the animal habitats.

Emerging and Re-emerging Infectious Diseases are unpredictable and create a gap between
planning and concrete action. To address this gap, there is a need to come up with proactive
systems that would ensure preparedness and response in anticipation to negative consequences
that may result in pandemic proportions of diseases. Proactive and multi- disciplinary
preparedness must be in place to reduce the impact of the public the health threats.
Vision
A health system that is resilient, capable to prevent, detect and respond to the public health
threats caused by emerging and re-emerging infectious diseases
Mission
Provide and strengthen an integrated, responsive, and collaborative health system on emerging
and re-emerging infectious diseases towards a healthy and bio-secure country.
Goal
Prevention and control of emerging and re-emerging infectious disease from becoming public
health problems, as indicated by EREID case fatality rate of less than one percent
 Program Strategies
The EREID Strategies are:
 Policy Development
 Resource Management and Mobilization
 Coordinated Networks of Facilities
 Building Health Human Resource Capacity
 Establishment of Logistics Management System
 Managing Information to Enhance Disease Surveillance
 Improving Risk Communication and Advocacy
Target Population/ Client
All ages; Citizen of the Philippines
Area of Coverage
Philippines and it’s international borders

Strategies, Actions Points

To achieve this goal within the medium term, with a benchmark of less than one percent EREID
case fatality rate, the EREID Program Strategic Investment Plan highlights the seven Strategic
Priorities, each with the following goals:
1. Policy Development: Establish updated, relevant, and implementable policies on EREID
providing the overall direction in implementing the different Program components for all the
network of health providers and facilities.
2. Resource Management and Mobilization: Effectively manage and mobilize available resources
from the DOH and partners both local and international needed in EREID detection,
preparedness, and response.
3. Coordinated Networks of Facilities: Organize adequate and efficient systems of coordination
among network of facilities both public and private needed in EREID detection, preparedness,
and response within the context of integrated health service delivery system at national and
sub-national levels.
4. Building Health Human Resource Capacity: Health care professionals skilled, competent and
motivated in detection, prevention and management of EREID cases, with provision of
supervised psychosocial support and risk communication at the national and sub-national levels.
5. Establishment of Logistics Management System: Manage the systems of procurement and
distribution of logistics for EREID detection, preparedness and response under each mode of
disease transmission.
6. Managing Information to Enhance Disease Surveillance: Improve case detection and surveillance
of EREID to prevent and or minimize its entry and spread and to mitigate the possible impact of
widespread community and national transmission.
7. Improving Risk Communication and Advocacy: Institute a risk communication and advocacy
system that is factual, timely and context relevant implemented at the national and sub-national
level.
 VI. Assessment

Write an essay of not more than 400 words about a pressing current problems of the Philippine
heath care system. Identify one only. Provide facts. Explain and justify why you say so. Provide
evidences to support your argument.

Note: Use Times New Roman font; font size 12; 1.5 spacing

References

Dayrit, M., Lagrada, L., Picazo, O., Pons, M., & Villaverde, M. (2018). Health Systems in Transition, vol. 8
No. 2 2018. The Philippines Health System Review.

Department of Health (2009). Implementing health reforms towards rapid reduction in maternal and
Neonatal Mortality. Manila, Philippines: Department of Health.

Department of Health. (2018). National objectives for health Philippines 2017-2022. Manila, Philippines:
Department of Health.

Prepared by:

Joycelyn A. Filoteo, RN, MPH

Faculty