Philippine Health Care Delivery System

NCM 104
Learning Outcome

•Engage in advocacy activities to influence health

and social care service policies and access to
services.
 A. The Department of Health
1. Vision/Mission/ Objectives/Strategic Goals
2. National Objectives for Health
3. The Millennium Development Goals.
a. Eradicate extreme poverty and hunger.
b. Achieve universal primary education
c. Promote gender equality and empowerment of
Contents women
d. Reduce child mortality.
e. Improve maternal health
f. Combat HIV/AIDS, malaria and other diseases
g. Ensure environmental sustainability
h. Develop a global partnership for development
4. Levels of Health Care Facilities
5. Health Devolution in the Philippines
Vision

• Filipinos are among the healthiest

people in Southeast Asia by 2022,
and Asia by 2040
Mission
• To lead the country in the
development of a productive,
resilient, equitable and
people-centered health system
The Department of
Health (DOH) holds the
over-all technical
authority on health as it is
a national health
policymaker and
regulatory institution.
DOH Three Major Roles in the
Health Sector

• Leadership in Health
• Enabler and Capacity Builder
• Administrator of Specific Services
• Its mandate is to develop national plans, technical standards, and guidelines on health.
• Aside from being the regulator of all health services and products, the DOH is the provider of special tertiary health care
services and technical assistance to health providers and stakeholders.
While Pursuing Its Vision, The DOH
Adheres to the Highest Values of
Work, Which are
National Objectives for Health Philippines 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
• Performance Accountability.
This ultimately leads to the three major
goals that the Philippine Health Agenda
aspires for:

• Better health outcomes with no major disparity among population groups;

• Financial risk protection for all especially the poor, marginalized and vulnerable; and
• A responsive health system which makes Filipinos feel respected, valued and
empowered.
Summary of
Selected
Health
Outcomes -
Philippines
Ten Leading Causes of Mortality – Philippines,
2016
Ten Leading Causes of
Morbidity – Philippines, 2016
The
Millennium
Development
Goals
The Millennium Development
Goals
• At the start of the century, all 189 United Nations Member States unanimously agreed to
forge a commitment via the Millennium Declaration to assist the poorest to achieve
better living standards by the year 2015.
The Millennium Development
Goals
• The United Nation’s member states Millennium Development Goals (MDGs) for 2015
include reducing maternal and neonatal mortality rates, infectious diseases such as
HIV/AIDS and tuberculosis. Significant progress has been made and the member states
particularly developing countries made substantial headway so far in attaining these
goals.
In the Philippines, one of the main reasons for the country’s
relentless pursuit of ensuring access to quality health care
services through its Universal Health Care platform is the
attainment of the targets that the country has committed in
the Millennium Development Goals (MDGs).
The Department of Health as the leader in health,
has initiated the implementation of health reforms
for the rapid reduction of maternal and neonatal
mortality.
MDG1 – Eradicate Extreme Poverty and Hunger

• Millions continue to live in hunger and poverty, lacking

access to basic services
• Despite remarkable progress, about 800 million people
continue to live in absolute poverty and suffer from hunger.
More than 160 million children below 5-years have
inadequate height for their age because of insufficient food.
MDG2 – Achieve Universal Primary Education

• In 2015, 57 million children of primary school age do not

attend school.
• Compared to children in the richest households, those in the
poorest households are four times more likely to be out of
school. Under-five mortality rates are nearly twice as high for
children in the poorest households compared to the
wealthiest households.
MDG 3: Promote gender equality and empower
women

• Gender inequality persists.

• Women in many parts of the world continue to face
discrimination in access to economic assets, work, and
participation in public and private decision-making.
• They are also more likely to live in poverty compared to men.
MDG 3: Promote gender equality and empower
women

• In 85 percent of the 92 nations with data on the rate of

unemployment based on the level of education between
2012 and 2013, women with tertiary education tend to have
higher rates of unemployment compared to men with similar
levels of education.
MDG 4: Reduce child mortality

• About 16,000 children die each day before they reach five
years of age, mostly due to preventable causes.
• In the developing nations, children from 20 percent of the
poorest households are more than twice as likely to be
stunted as those from 20 percent of the wealthiest.
MDG 5: Improve Maternal Health

• The maternal mortality ratio in developing nations is 14 times

higher than in the developed nations.
• J50 percent of pregnant women in developing countries can
receive the recommended minimum of 4 antenatal care visits
• In rural areas, 44 percent of births are done in the absence of
skilled health personnel, compared with 13 percent in urban areas.
MDG 6: Combat HIV/AIDS, Malaria and Other
Diseases

• An estimated 36 percent of the 31.5 million people living

with HIV in developing nations were said to be
receiving antiretroviral therapy (ART) in 2013.
MDG 7: Ensure • Close to 5.2 million hectares of forest cover
were lost in 2010.
Environmental • Climate change and environmental
Sustainability degradation undercut progress achieved
MDG 7: Ensure Environmental Sustainability
Global emissions of carbon dioxide have increased by more than 50
percent since 1990.
MDG 7: Ensure
Environmental
Sustainability
• The surge in greenhouse gas
emissions has impacted
climate change with regard to
weather extremes, altered
ecosystems, and risks to
society, which remain urgent
and critical challenges for the
universal community.
The overexploitation of marine fish stocks resulted in the decline in the
percentage of stocks within the safe biological limits – from 90 to 71 percent
between 1974 and 2011. Generally, all species are declining in numbers and
distribution, increasing the risk of extinction.
Water shortage
affects 40 percent
of the global
population and is
projected to
increase.
In 2015, an estimated 2.4 billion
people (One in three) use
unimproved sanitation facilities,
including 946 million people still
practicing open defecation.
About 84 percent of the rural population has
access to improved drinking water sources
compared to 96 percent of the urban dwellers.
MDG 8: Develop a Global Partnership for
Development

• Conflict remains the greatest threat to human development.

• By 2015, conflicts had forced nearly 60 million people to
leave their homes – the highest number recorded since the
Second World War
MDG 8: Develop a Global
Partnership for Development
• Every day, about 42,000 people are forcibly displaced and compelled to seek protection
due to conflicts, which is nearly 4 times the number in 2010 (11,000).
MDG 8: Develop a Global Partnership for Development

• 50 percent of the global refugee population is made up of children, which has constituted to the increase in
number of out-of-school children from 30 percent to 36 percent between 1999 and 2012.
 In September 2015, the United Nations Member
States adopted a new global plan of action entitled,
“Transforming Our World: The 2030 Agenda for
Sustainable Development.”
The 2030 Agenda, its 17 Goals and 169 targets are
a universal set of goals and targets that aim to
stimulate people-centered and planet-sensitive
change.
The 193 member states of the United Nations
(UN) gathered to affirm commitments towards
ending all forms of poverty, fighting
inequalities and increasing country’s
productive capacity, increasing social inclusion
and curbing climate change and protecting
the environment while ensuring that no one is
left behind over the next fifteen years.
Difference Between SDGs and MDGs

SDGs benefit from the valuable lessons learned from MDGs.

These also carry forward the unfinished agenda of MDGs for continuity and sustain the
momentum generated while addressing the additional challenges of inclusiveness, equity,
and urbanization and further strengthening global partnership by including CSOs and
private sector.

They reflect continuity and consolidation of MDGs while making these more
Health Devolution in the Philippines

• In 1991 the Philippine Government introduced a major devolution of national

government services, which included the first wave of health sector reform,
through the introduction of the Local Government Code of 1991.
• The Code devolved basic services for agriculture extension, forest management,
health services, barangay (township) roads and social welfare to Local
Government Units.
Health Devolution in the Philippines

•In 1992, the Philippine Government devolved the

management and delivery of health services from the
National Department of Health to locally elected
provincial, city and municipal governments.
Local Government Code
of 1991 Republic Act No.
7160 has changed the
way basic government
health services are
delivered at the local
level.
From a highly centralized system of health
service delivery with the Department of
Health (DOH) as the sole provider, the
Code mandated the devolution to local
government units (LGUs) of many of the
functions previously discharged by DOH.
As a result of health
devolution, LGUs have taken
on the great responsibility in
the delivery of basic services
and in the operation of
facilities in areas that include
primary health care and
hospital care/services.
Implications of Health Devolution: Issues and Challenges

The fact remained that many LGUs were not ready for the
devolution in terms of both financial and human resource.

Fiscal capacity of LGUs and managerial capability of local chief

executives (LCEs) were not considered prior to devolution.

There was no capacity building for local officials and health

personnel before the devolution (Grundy et al. 2003).
Implications of Health Devolution: Issues and Challenges

There was no sufficient preparation that would enable all those

affected by health devolution to cope with the tremendous
changes it brought (DOH 1997).

Local Health Board (LHB), were conducted in 1994

A strategic plan for the introduction of devolution (i.e., prior to

health devolution) was lacking (Grundy et al. 2003).
The issues and challenges of health devolution can be summarized into
three broad topics, namely:

Organization/Structural
Financial Issue Health personnel
Change
Financial Issue
• Mismatch between the internal revenue allotment (IRA) and the cost of devolved
functions
• Many provinces and smaller municipalities had insufficient funds to pay the salaries of the
national workers devolved to them (Perez 1998a and Perez 1998b), not to mention the
cost of implementing the Magna Carta for public health workers as mandated in
Republic Act 7305 of 1992.
Health Personnel

• Some LGUs refused to accept the devolved health workers for

varying reasons. In response, the Oversight Committee for the
Code held hearings in all regions to address the
misunderstanding among local governments, devolved
workers, and concerned national government agencies.
Health Personnel
• In Metro Manila, some municipal mayors were not willing to absorb the cost of devolved
health personnel because they believed that it was estimated based on questionable
plantilla while some other municipal mayors thought that having too many highly paid
workers, particularly doctors, would hinder their plans for cityhood and still some others
thought that the salaries of devolved workers would be higher than that of the existing
city health officers.
Organization/Structural Change
• The Code requires the creation and composition of a Local Health Board (LHB) in every
province, city, or municipality with the local chief executives (i.e., governor in the case of
provinces and mayor in the case of cities and municipalities) as chair and the local health
officers as vice-chair.
Local Health Board
• It is tasked to prepare the annual budget for health, act as an advisory committee on
health matters, and create committees that shall guide in personnel selection and
promotion, bids and awards, and budget review, among others (Book I, Title Five,
Section 102).
Health devolution affected the Delivery Health System
to a large extent because it disintegrated the chain of
health care delivery system when the administration of
health facilities was transferred from the province to
different jurisdictions
Primary

• Barangay Health Stations (BHS)

are managed by barangay and
municipal/city governments
while rural health units (RHUs)
and city health centers are
managed by municipal and city
governments, respectively
Secondary

• Municipal or District
Hospitals/Provincial Hospitals
are managed by provincial
government
Tertiary

• Provincial Hospitals are managed by provincial

hospitals and regional hospitals (also known as
retained hospitals) are managed by the DOH
 Levels of Health Care Facilities
There are 3 different levels of health care system
Primary Level of Care

Devolved to cities and municipalities

Usually the first contact between the community members

and other levels of health facility.

Center physicians, public health nurse, rural health midwives,

barangay Health workers, traditional healers.
Secondary Level of Care
• Given by physicians with basic health training.
• Usually given in health facilities either private owned or government operated.
• Infirmaries, municipal, district hospital, out-patient departments.
• Rendered by specialists in health facilities.
Tertiary Level of Care
• Referral system for the secondary care facilities.
• Provided complicated cases and intensive care.
• Medical centers, regional and provincial hospitals and specialized hospitals.
END