Home

PNCM 1044: Community Health Nursing I: Individual and Family as Client

MIDTERM WEEK 3

Learning Content
PHILIPPINE HEALTH CARE DELIVERY SYSTEM

The Philippine health care system has rapidly evolved with many challenges through time. Health service delivery was devolved to the Local Government Units
(LGUs) in 1991, and for many reasons, it has not completely surmounted the fragmentation issue.

The Philippines, the health system is a complex, multi-layered system in which responsibilities in the health care sector are fragmented Responsibility is shared between
the central government and Local Government Units that have full autonomy to organize and finance their ‘own’ regional

HISTORY OF HEALTH CARE DELIVERY SYSTEM IN PHILIPPINES

1. Pre-Spanish and Spanish periods (before 1898)

- traditional health care (herbs & rituals)

- dispensary of indigent patients of Manila

- Medicus Titulares

- Superior Board of Health & Charity, 1888

2. June 23, 1898

- creation of E. Aguinaldo government of Department of Public Works, Education & Hygiene

2.
September 29, 1898

- gen. order no. 15 established the Board of Health for the City of Manila
3.
July 1, 1901

- Act no. 157: Board of Health of Philippine Islands

- Acts no, 307 & 308: provincial and municipal boards

4.
October 26, 1905

- Act no. 1407: establishment of Bureau of Health

6. 1912
- Act no. 2156 (Fajardo Act): health fund for travel and salaries
5.
1915
- Act no. 2568: from BOH to Philippine Health Service “semi-military system of public health administration”
6.
August 2, 1916

- Act 2711 w/c included the Public Health Law of 1917

7.
1932
- Act no. 4007: Reorganization Act of 1932

8.
May 31, 1939

- Commonwealth act no. 430 created the Department of Public Health & Welfare, but was only completed through E.O. no. 317, Jan. 7, 1941 Dr. Jose Fabella
became its first secretary
9.
October 4, 1947

- E.O. no. 94: post war reorganization of the Department of Health & Public Welfare

- resulted in the split of Department of Public Welfare (w/c became Social Welfare Administration) and Philippine General Hospital to the Office of the President

 - another split between curative (Bureau of Hospitals) & preventive services (Bureau of Health)

- Nursing Service Division was also established

10.
January 1, 1951

- conversion of Sanitary District to Rural Health Unit, carrying the ff. services:

*maternal & child health

*environmental health

*communicable disease control

*vital statistics

*medical care

*health education

*public health nursing

- resulted in passage of Rural Health Act of 1954 (RA 1082)

13. 1970
- conceptualization of the Restructured Health Care Delivery System (primary, secondary & tertiary levels of care)

14. June 2, 1978

- P.D. 1937 renamed DOH to Ministry of Health during the Martial Law

- Sec. Gatmaitan was the 1st minister of health

15. December 2. 1982

- E.O. 851 reorganized Ministry of Health as an integrated health care delivery system through the

creation of Integrated Provincial Health Office, combining the public health and hospital operations

under the PHOs

11.
16. April 13, 1987

- E.O. no. 119: MOH was back in the name Department of Health by President Cory Aquino

October 10, 1991

- RA 7160 known as the Local Government Code: all structures, personnel & budgetary allocations from the provincial health level down to the brgy were
devolved to the LGU to facilitate health service delivery

-From PROVINCIAL TO LOCAL GOVERNMENT (devolution/ devolved health sector)

18. May 24, 1999

- E.O. 102 “Redirecting the Functions & Operations of the DOH” by Pres. Joseph Estrada

19. 1999-2004

- Development of the Health Sector Reform Agenda

12.
2005 to present

- development of a plan to rationalize the bureaucracy in an attempt to scale down including the DOH

DEPARTMENT OF HEALTH

Vision — The DOH envisions Filipinos as among the healthiest people in Southeast Asia by 2022, and in Asia by 2040.

Mission — The DOH shall lead the country in the development of a productive, resilient, equitable, and people—centered health system.

Core Values —- The DOH shall embody at all times integrity, excellence, and compassion in carrying out its tasks and responsibilities.

DOH ORGANIZATIONAL STRUCTURE

The Philippines, the health system is a complex, multi-layered system in which responsibilities in the health care sector are fragmented Responsibility is shared between
the central government and Local Government Units that have full autonomy to organize and finance their ‘own’ regional

ROLES AND FUNCTIONS OF DOH

1. Leadership in Health

- national policy & regulatory institution

- leadership in formulation, monitoring, & evaluation of health policies, plans & programs
- serve as advocate in health policies, plans & programs

2. Enabler & Capacity Builder

- innovate new strategies in health

- monitoring & evaluation of national health policies, plans & programs

- ensure highest achievable standards of quality HC, health promotion & health protection

3. Administrator of Specific Services

- manage selected national & sub-national health facilities & hospitals w/ modern facilities that shall serve as referral centers

- administer direct services for emerging health concerns

- emergency response services in disaster and epidemics

HEALTH FACILITIES

Health facilities in the Philippines include government hospitals, private hospitals and primary health care facilities.

Hospitals are classified based on ownership as public or private hospitals.

1. Public/ government owned hospitals/ health care facilities

The Department of Health directly supervises and controls the management and operations of 66 hospitals. All administrative regions in the country have DOH hospitals, 38
of which are located in Luzon, 12 in Visayas, and 16 in Mindanao. Majority of these facilities are Level 3 Hospitals (56%).
In addition, there are four specialty hospitals attached to the DOH operating as Government-Owned and -Controlled Corporations (GOCC) namely, National Kidney and
Transplant Institute, Philippine Heart Center, Philippine Children’s Medical Center and Lung Center of the Philippines. Moreover, there are two extension
hospitals, one hospital is currently operating as a Program Management Office (Philippine Cancer Center), and four hospitals that are transitioning operations from their
respective local governments to the DOH.

1. Private hospitals/ health care facilities

The private sector consists of thousands of for-profit and nonprofit health providers, which are largely market-oriented and where health care is generally paid for through
user fees at the point of service.
The private health sector is regulated by the Government through a system of standards and guidelines implemented through the licensure procedures of the DOH and the
accreditation procedures of PhilHealth.
Private sector provides also medical tourism, mostly for low cost aesthetic and dental procedures.

2 divisions:

FORMAL PRIVATE SECTOR- consists of clinics, infirmaries, laboratories, hospitals, drug manufacturers and distributors, drugstores, medical supply companies and
distributors, health insurance companies, health research institutions and academic institutions offering medical, nursing, midwifery, and other allied professional health
education.
NON-FORMAL HEALTH SERVICE PROVIDERS - include traditional healers (herbolarios) and traditional birth attendants (hilots), which are not covered by any
licensing or accreditation system by the Government.

CATEGORIES OF HEALTH CARE DELIVERY

Type Services Level Prevention Example Location

PRIMARY ·        Common health ·        Primary Prevention:·        Health Education ·        RHU
problems
Health Promotion ·        Immunization ·        City health Unit
·        Health Education
Illness Prevention ·        Chemoprophylaxis ·        Community
·        Preventive Care Hospitals
 ·        Personality development

·        personal hygiene

·        responsible sexuality

·        fertility regulation

·        avoidance of allergens,

poisons and carcinogens

Through environmental
control:

·        safe water

·        food hygiene

·        safe excreta disposal

·        proper refuse management

·        safe home environment

·        safe workplace

·        Prompt Treatment

·        Secondary ·        Contact Tracing

Prevention
·        Case Finding
·        District/ Provincial
Diagnosis
Hospitals
SENCONDARY·        Medical Services ·        Screening
Treatment
·        City Hospitals
·        Multi-phasic screening
Complication
Prevention ·        Surveillance

·        Tertiary Prevention ·        Regional

·        Advance and ·        Physical Therapy
Specialized Medical
TERTIARY Specialized Medical Disability Prevention
and National Health
Services ·        Facilities Employment 
Rehabilitation Centers

HEALTH HUMAN RESOURCE

The health human resources are the main drivers of the health care system and are essential for the efficient management and operation of the public health system. They
are the health educators and providers of health services.

The Philippines has a huge human reservoir for health. However, they are unevenly distributed in the country. Most are concentrated in urban areas such as Metro
Manila and other cities.

As of April 2020, there were approximately 14.8 nurses per 10,000 population in the Cordillera Administrative Region (CAR) of the Philippines. In comparison, there
were only 3.8 nurses per 10,000 inhabitants in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM).

REFERRAL SYSTEM IN LEVELS OF THE HEALTH CARE

Barangay Health Station (BHS) is under the management of Rural Health Midwife (RHM)
Rural Health Unit (RHU) is under the management or supervision of PHN.
Public Health Nurse (PHN) caters to 1:10,000 population, acts as managers in the implementation of the policies and activities of RHU, directly under the supervision of
MHO (who acts as administrator)

TWO-WAY REFERRAL SYSTEM

A two-way referral system need to be established between each level of health facility e.g. barangay health workers refer cases to the rural health team, who in turn
refer more serious cases to either the district hospital, then to the provincial, regional or the whole health care system.
BHS→ RHU→ MHO→ PHO→ RHO→ National Agencies

MULTISECTORAL APPROACH TO HEALTH

The level of health of a community is largely the result of a combination of factors of other health-related Systems (government/private)