Module 2

Health Care Delivery System

MAE – JOANNE M. BONGAT, MAN

Assistant Professor I
Introduction
A Public Health Nurse does not function in a vacuum. She is a member of a team working within
a system. In order for the nurse to function effectively, she has to understand the health care delivery
system wherein she is working because it influences her status and functions. She needs to properly
relate with the dynamics of the political, organizational structure surrounding her position in the health
care delivery system.
The Philippines health care delivery system is composed of two sectors: (1) the public sector,
which is largely financed through a tax – based budgeting system at both national and local levels and
where health care is generally given free at the point of service (although socialized user fees have been
introduced. In recent years for certain types of services (2) the private sector (for – profit and non –
profit providers), which is largely market – oriented and where health care is paid through user fees at
the point of service.
The public sector consists of the national and local government agencies providing health
services. At the national level, the Department of Health (DOH) is mandated as the lead agency in health.
It has a regional field office in every region and maintains specialty hospitals, regional hospitals and
medical centers. It also maintains provincial health teams made up of DOH representatives to the local
health boards and personnel involved in communicable disease control, specifically for malaria and
schistosomiasis. Other national government agencies providing health care services such as the Philippine
General Hospital are also part of this sector.
With the devolution of health services, the local health system is now run by Local Government
Units (LGUs). The provincial and district hospitals are under the provincial government while the
city/municipal government manages the health centers/rural health units (RHU) and barangay health
stations (BHS). In every province, city or municipality, there is a local health board chaired by the local
chief executive. Its function is mainly to serve as advisory body to the local executives and the
sanggunian or local legislative council on health – related matters.
The private sector includes for – profit and non – profit health providers. Their involvement in
maintaining the people’s health is enormous. This includes providing health services in clinics and
hospitals, health insurance, manufacture of medicines, vaccines, medical supplies, equipment and other
health and nutrition products, research and development, human resource development and other health
– related services.

Lesson 3: World Health Organization

A. Millennium Development Goal
B. Sustainable Development Goal

Objectives:
At the end of the module, you are expected to:
1. Assume responsibility for lifelong learning, own personal development and maintenance of
competence.
2. Engage in advocacy activities to influence health and social care service policies and access to
services
3. Model professional behavior as a community health nurse.
4. Assess with the individual and family one’s health status/competence.
5. Formulate with the client a plan of care to address the health conditions, needs, problems, and
issues based on priorities.
6. Implement safe and quality interventions with the client to address the health needs, problems
and issues.
7. Provide health education using selected planning models to targeted clientele (individuals and
families) in the community
8. Participate in research study as member of a research team.
9. Evaluate with the client the health status/competence
 At the start of the module, you are to take pre assessment test to see how much background
information and knowledge you have.
This module is self – instructional. You can read, analyze concepts and ideas presented and relied
on them. The Activities and Self – Check Questions will help you assess how you progress as you go
through the module.
Yours answers to the Self – Check Questions and Activities may be self – evaluated by your
facilitator if you so desire. These will be part of your formative evaluation. Do not write your answers in
the module. Your answers should be written in a separate notebook.
The answer key to the Self – Check Questions and Activities are found at the end of this module.
The post assessment will be given in a separate booklet upon completion of the module. It will serve as
the summative evaluation of your performance.
Remember, you are to work on this module independently. I shall not be around to supervise you
as you go through each lesson. It is expected that you will make the most of this module and grow
professionally in your desire to become a competent Nurse, determined to make a difference.

Pre - Assessment Test

Multiple Choice:
Take the quiz: How much do you know about SDGs and MDGs? Read the sentence carefully. Choose the
best answer. Write the letter of your answer on a separate sheet.
1. How many Sustainable Development Goals (SDGs) have been agreed to by all the world’s
nations, as part of the 2030 Agenda?
a. 17 c. 10
b. 8 d. 16, plus a few statements about implementation
2. Each SDG is supported by a set of Targets-specific objectives that are associated with that Goal.
How many targets are there in total?
a. 99 c. 169
b. 1016 d. 51
3. Goal 1 is about poverty. What is the aim of this Goal?
a. Cut poverty in half by 2030
b. Reduce poverty by 75% by 2030
c. End poverty in all its forms everywhere
d. Help each nation make progress on reducing poverty
4. Goal 17 is about strengthening the “means of implementation” and revitalizing the “Global
Partnership” for realizing all the other Goals. Which of the following is not part of Goal 17?
a. Mobilizing the financial resources necessary to achieve the Goals
b. Creating international sports tournaments and festivals to promote the Goals
c. Helping developing countries build the capacities they need in areas such as technology,
public policy and data for reporting on progress
d. Enhancing trade, especially to help developing countries increase their exports and grow
their economies.
5. In the 2030 Agenda, Sustainable Development Goal #13 on climate change, has * (asterisk) after
it. Why?
a. Because addressing climate change is more important than all the other Goals
b. Because the negotiation were unable to come to an agreement on a climate change Goal.
c. Because the UN Framework Convention on Climate Change (which is meeting in Paris in late
2015) is the forum where more detailed decisions on climate will be made
d. Because the Goal on climate change is constantly shifting
6. Which of the following is not part of the Sustainable Development Goals?
a. Access to sustainable energy for all
b. Availability of water and sanitation for all
 c. Provision of internet services for all
d. Promotion of decent jobs for all
7. Equality issues are specifically mentioned in how many of the sustainable Development Goals
(not including the targets)?
a. In two of them: Goal 6 on water and Goal 12 on sustainable production and consumption
b. In four of them: Goal 2 on hunger; Goal 7 on energy, Goal 8 on economic growth and jobs
ang Goal 14 on preserving the oceans and seas
c. In three of them, Goal 4 on education, Goal 5 on gender and Goal 10 on reducing inequality
within and among countries
d. In one of them, Goal 16 on promoting peaceful and just societies for all
8. Which of the following is not part of Goal 15, on ecosystems?
a. Halt and reverse and degradation
b. Halt biodiversity loss
c. Halt the use of biotechnology and genetic engineering
d. Use ecosystem sustainably while protecting and restoring them
9. Which of the following is not true about the SDGs?
a. They encourage the promotion of health, well – being, and education for all, at all ages
b. They explicitly promote innovation
c. They include the development of sustainable cities, infrastructure and industry
d. They are a legally binding international treaty that all nations are required to follow
10. What can individuals do to help realize the achievement of the Sustainable Development Goasl?
a. Hold their governments and the private sector accountable and support reputable civil society
organizations
b. Create projects and partnerships of their own and participate in existing initiatives to help
achieve one or more of the goals
c. Use their position in society – as teachers, decision – makers, consumers, role models and
ordinary citizens – to voice support for the Goals, to make decisions that advance the Goals
and to take actions help to implement the Goals
d. All of the above
11. How many MDGs are there?
a. 8 c. 12
b. 10 d. 15
12. MDG is to eradicate extreme poverty and hunger. What does the UN currently define as the
global poverty rate?
a. $1 a day c. $1.25 a day
b. $0.5 a day d. $2 a day
13. Which of the following is not a MDG?
a. Improve maternal health
b. Achieve universal access to safe drinking water, sanitation and hygiene
c. Ensure environmental sustainability
d. Achieve universal primary education
14. According to the UN, which MDG has been achieved?
a. Reduce the maternal mortality rate by three – quarters
b. Halt and begin to reverse the spread of HIV – Aids
c. Reduce the under five mortality rate by two – thirds
d. Halve the number of people living in extreme poverty
15. Fill in the gap, MDG is to combat HIV – Aid, _________ and other diseases
a. Tuberculosis c. diarrhea
b. Malaria d. cholera

Let’s Read Lesson 3: World

Health Organization
Introduction
 WHO is a specialized agency of United Nations
 WHO is established on 7th April 1948.
 The headquarters of WHO is located in Geneva.
 WHO serves as the directing and coordinating authority for International health matters and
public health.
History
 First global health organization. In latter half of 19 th century, severe cholera epidemics was
occurred. At that time, series of International sanitary conferences were held in Europe to
coordinate policy and practice around quarantine and disease management.
 The League of Nations established a health organization in 1920.
Establishment
 Establishment of United Nations is in 1945, marked as a period of aggressive internationalism
and international organization building and though health was not initially thought to be under
the UN
 After its motion started by Brazilian and Chinese delegates to establish an international health
organization and that was generally accepted.
 A group of health experts, working on emergency relief in World War II were charged with the
task of drafting a constitution to define the structure and mandate of the body that would
become known as the World Health Organization (WHO)
 Finally, WHO’s constitution came into force on 7 th April 1948. This date celebrates every year as
“World Health Day” by all over world.
Objective of WHO
 To develop and implement multisectoral public policies for health, integrated gender and age
sensitive approaches that facilitate community empowerment, together with action for health
promotion, self care and health protection throughout the life course in cooperation with the
relevant national and international partners.
World Health Assembly
 The World Health Assembly is the supreme decision making body for WHO.
 It generally meets in Geneva in May each year. And is attended by delegations from all 194
member states.
 The Health Assembly appoints the Director General. The Current Director General of WHO is Dr.
Tedros Adhanom an Ethiopian Nationalist, who started his 5 year term on 1st July 2017.
A. Millennium Development Goal
 What Are the Millennium Development Goals
 The Millennium Development Goals (MDGs) are eight goals to be achieved by 2015
that respond to the world’s main development challenges.
 The MDGs are drawn from the actions and targets contained in the Millennium
Declaration that was adopted by 189 nations and signed by 147 heads of state and
government during the UN Millennium Summit in September 2000.
 The Millennium Development Goals (MDGs) which are based on the fundamental
values of freedom, equality and solidarity, tolerance, health, respect for nature and
shared responsibility. The Eight Millennium Development Goals are as follows:

https://www.youtube.com/watch?v=A5giOGjj5X8
 1. Eradicate extreme
poverty and
1. Reduce by half the proportion of people living
hunger
on less than a dollar a day.
2. Achieve full and productive employment and
decent work for all including women and young
people.

2. Achieve Universal Primary Education

Ensure all boys and girls complete a full course of

primary schooling.

3. Promote Gender Equality and Empower Women

Eliminate gender disparity in primary and secondary

education preferably by 2005 and at all levels by 2015.

4. Reduce Child Mortality

 Reduce by two thirds the mortality rate among children
under five.

5. Improve Maternal Health

 Reduce by three quarters the maternal mortality

rate
 achieve by 2015, universal access to reproductive
health

6. Combat HIV/AIDS, Malaria and Other Diseases

 Halt and begin to reverse the spread of HIV/AIDS

 Achieve by 2010, universal access to treatment for
HIV/AIDS for all those who made it.
 Halt and begin to reverse the incidence of malaria
and other major disease.

7. Ensure Environmental Sustainability

1.Integrate the principle of sustainable development into

country, policies and programmes reverse loss of
environmental resources.

2. Reduce by half the proportion of people without

sustainable access to safe drinking water and basic
 8. Global Partnership for Development

Deal comprehensively with the debt problems of developing

countries through national and international measures in
order to make debt sustainable in the long term.

Except for goals 2 and 3, all the MDGs are health or health related. Health is essential to the achievement
of these goals and is a major contributor to the overarching goal of poverty reduction.
In order to achieve these goals, the participation of all members of the society from both developing and
developed countries is required. Achievement of these goals by 2015 is now a priority of the global
community and dictates the priority public health programs that should be implemented.
At the country level, the Philippines has experienced considerable improvements in its health status for
the past 50 years, yet it has also in recent years experienced decline as shown in its poor performance in
reducing infant and maternal mortality rates. The Philippines is also experiencing an epidemiologic shift,
which means that while it is still contending with the burden of communicable diseases, it is also at same
time contending with the devastation brought about by non - communicable, chronic – lifestyle – related
diseases. Currently, the country is being threatened with the devastating effect of a “Triple whammy”
which will be brought about not only by this epidemiologic shift but also by the emergence of plague –
like infectious diseases such as Severe Acute Respiratory
Syndrome (SARS) and Avian Flu. With this scenario, the need to strengthen the capability of the public
health infrastructure including the Public Health Nurse to adequately respond is imperative.

B. Sustainable Development Goal

https://www.youtube.com/watch?v=_qLqLJq2954
On September 25, 2015, 193 heads of state at the United Nations General Assembly set up a collection of
17 goals known the Sustainable Development Goals (SDGs) Or Simply Global Goals.
The SDGs and their 169 targets form the core of Resolution 70/1 of the United Nations, which is a
breakthrough agreement called AGENDA 2030. The goals are to be achieved by all member states by
year 2030.
They are a universal call to action to end poverty, protect the planet and ensure all people enjoy peace
and prosperity.
The goals are broad, interdependent and cover social, economic and social issues and making them work
is everyone’s responsibility.
The following slides present a brief overview of the goals.

Poverty is defined as income less than 1.25 USD per day.

The targets for this goal include a world where the poor are not
vulnerable to climate change and have equal rights to economic
resources.
Economic growth must be inclusive to provide sustainable jobs 1. End Poverty in All
and promote equality Its Forms
Everywhere
The goal aims to eradicate extreme poverty by year 2030.

2. End Hunger, Achieve food Security and Improved Nutrition and Promote Sustainable
Agriculture
 Many still suffer from hunger and malnutrition around the
world, mostly women and children.
The food and agriculture sector offers key solutions for
development and is central for hunger and poverty eradication.
Targets for this goal include ending malnutrition, protecting
small farmers, protecting the genetic diversity of crops produced
and investing in research to make farming more productive.
3. Ensure Healthy
Lives and
Ensuring healthy lives and promoting the well being for all at all Promote Well –
Being for all at All
ages is essential to sustainable development. Ages
Goal includes calls for universal health coverage, increasing
health care workforce, reducing illness and death by pollution,
comprehensive agenda for tackling a wide range of global health
challenges such as AIDS, malaria, tuberculosis
Vaccinate your family to protect them and improve public health

4. Ensure Inclusive and Equitable Quality Education and Promote Life Long Learning
Opportunities for
Obtaining a quality education is the foundation to improving all
people’s lives and sustainable development.
Targets for this goal include the need for access to university
level education, vocational training and entrepreneurial skills.
Help children in your community to read.

5. Achieve Gender Equality and Empower All Women and Girls

Gender equality is not only a fundamental human right, but is

necessary foundation for a peaceful, prosperous and sustainable
world.
Targets for this goal include freedom from discrimination and
violence, ensuring equal share of leadership opportunities and
responsibilities for women as well as property ownership.
Several references are made to “national appropriateness” in
interpreting these targets.
Call out sexist language and behaviors.
 6. Ensure
Availability
Clean, accessible water for all is an essential part of the world we
and
want to live in. Sustainable
Basic water scarcity affects 40% of world population. Management
Targets for this goal include programs that provide access to basic of Water and
technologies like toilets or latrines as well as protecting ecosystems Sanitation For
that provide water. All
Avoid wasting water.

7. Ensure
Energy is central to nearly every major challenge and opportunity. access to
Affordable,
About 1.3 billion people globally have no access to electricity. Reliable,
Targets for this goal emphasizes a conversion to renewable sources Sustainable
and a dramatic improvement in efficiency everywhere. and Modern
Use only energy efficient light bulbs or appliances. Energy For
All

8. Promote Sustained, Inclusive and Sustainable Economic Growth, Full and Productive
Employment and
Sustainable economic growth will require societies to create the Decent Work For
all
conditions that allow people to have quality jobs.
About 75 million people between ages 15 and 24 are estimated to be
unemployed and out of school globally.
This goal targets closing the gap using innovation, as well as separating
growth from ecosystem degradation.

9. Build Resilient Infrastructure, Promote Inclusive and Sustainable Industrialization

and Foster Innovation
 Investments in infrastructure are crucial to achieving sustainable
development.
Targets for this goal include fostering a more innovative and
environmentally sound approach to industrial development.
Think of innovative new ways to repurpose old material.

10. Reduced
Inequality within and Among Countries

The world is massively unequal.

To reduce inequalities, policies should be universal in principle, paying
attention to the needs of disadvantaged and marginalized populations.
Targets for this goal include financial market regulation to make the
playing field more equal, making migration more orderly, safe, regular
and responsible.
11. Make Cities and
Human Settlements Inclusive, Safe, Resilient and Sustainable

There needs to be a future in which cities provide opportunities for all

with access to basic services, energy, housing, transportation and more.
More than half the world population lives in cities. Targets for this goal
include addressing issues like transportation, disaster preparedness, as
well as preservations of the world’s cultural and natural heritage.
12. Ensure
Sustainable
This goal targets topics like reducing food wastage, corporate
sustainability practice, and educating people on the impact of their
lifestyle choices.

Recycle paper, glass, plastic and aluminum.

Consumption and Production Patterns

13. Take urgent actions to Combat Climate Change and its Impacts
 Climate change is a global challenge that affects everyone, everywhere.
This goal has an asterisk as it references the “Paris Agreement” of
December 2015, which guides nations to jointly commit to limiting global
warming to not more than 2 degrees Celsius.
Education young people on climate change to put them on a sustainable
path early.

14. Conserve and Sustainably Use the Oceans, Seas and Marine Resources for Sustainable

Careful management of this essential global resource is a key feature of

a sustainable future.
The world’s oceans are overfished, under-protected and stressed from
climate change and pollution.
The target for this goal include research and learning to find out more
about what lies beneath the oceans so as to better save them.
Avoid plastic bags to keep oceans safe and clean.

Development

15. Protect, Restore and Promote Sustainable Use of Terrestrial Ecosystems

Sustainably manage forests, combat desertification, halt and remove

land degradation, halt biodiversity loss.
This goal targets halting the threat to living ecosystems and
biodiversity on land.
Plant a tree and help protect the environment.
16. Promote
Peaceful and Inclusive Societies for Sustainable Development
 Access to justice for all, and building effective, accountable institutions
at all levels.
Targets for this goal include reduction of violence, end to torture,
reduction of corruption, as well as creation of institutions and
governments that work for everyone.
Use your right to elect the leaders in your country and local
community.

17. Strengthen the means of Implementation and Revitalize the Global Partnerships for
Sustainable
Every country and every sector has a role to play in achieving the Development
SDGs.
This goal targets ensuring that countries have what is needed in
achieving the rest of the SDGs such as funds, capacities and
technologies.
The goal emphasizes the need for partnership and collaboration.

Post Assessment Test

Take the quiz: How much do you know about SDGs and MDGs? Read the sentence carefully. Choose the
best answer. Write the letter of your answer on a separate sheet.

1. How many Sustainable Development Goals (SDGs) have been agreed to by all the world’s
nations, as part of the 2030 Agenda?
a. 17 c. 10
b. 8 d. 16
2. Each SDG is supported by a set of Targets-specific objectives that are associated with that
Goal. How many targets are there in total?
a. 99 c. 169
b. 1016 d. 51
3. Goal 1 is about poverty. What is the aim of this Goal?
a. Cut poverty in half by 2030
b. Reduce poverty by 75% by 2030
c. End poverty in all its forms everywhere
d. Help each nation make progress on reducing poverty
4. Goal 17 is about strengthening the “means of implementation” and revitalizing the “Global
Partnership” for realizing all the other Goals. Which of the following is not part of Goal 17?
a. Mobilizing the financial resources necessary to achieve the Goals
b. Creating international sports tournaments and festivals to promote the Goals

c. Helping developing countries build the capacities they need in areas such as technology,
public policy and data for reporting on progress
d. Enhancing trade, especially to help developing countries increase their exports and grow
their economies.
 5.In the 2030 Agenda, Sustainable Development Goal #13 on climate change, has * (asterisk)
after it. Why?
a. Because addressing climate change is more important than all the other Goals
b. Because the negotiation were unable to come to an agreement on a climate change
Goal.
c. Because the UN Framework Convention on Climate Change (which is meeting in Paris in
late 2015) is the forum where more detailed decisions on climate will be made
d. Because the Goal on climate change is constantly shifting
6.Which of the following is not part of the Sustainable Development Goals?
a. Access to sustainable energy for all
b. Availability of water and sanitation for all
c. Provision of internet services for all
d. Promotion of decent jobs for all
7.Equality issues are specifically mentioned in how many of the sustainable Development Goals
(not including the targets)?
a. In two of them: Goal 6 on water and Goal 12 on sustainable production and consumption
b. In four of them: Goal 2 on hunger; Goal 7 on energy, Goal 8 on economic growth and
jobs ang Goal 14 on preserving the oceans and seas
c. In three of them, Goal 4 on education, Goal 5 on gender and Goal 10 on reducing
inequality within and among countries
d. In one of them, Goal 16 on promoting peaceful and just societies for all
8.Which of the following is not part of Goal 15, on ecosystems?
a. Halt and reverse and degradation
b. Halt biodiversity loss
c. Halt the use of biotechnology and genetic engineering
d. Use ecosystem sustainably while protecting and restoring them
9.Which of the following is not true about the SDGs?
a. They encourage the promotion of health, well – being, and education for all, at all ages
b. They explicitly promote innovation
c. They include the development of sustainable cities, infrastructure and industry
d. They are a legally binding international treaty that all nations are required to follow
10.What can individuals do to help realize the achievement of the Sustainable Development
Goasl?
a. Hold their governments and the private sector accountable and support reputable civil
society organizations
b. Create projects and partnerships of their own and participate in existing initiatives to help
achieve one or more of the goals
c. Use their position in society – as teachers, decision – makers, consumers, role models
and ordinary citizens – to voice support for the Goals, to make decisions that advance the Goals
and to take actions help to implement the Goals
d. All of the above
11. How many MDGs are there?
a. 8 c. 12
b. 10 d. 15
12.MDG is to eradicate extreme poverty and hunger. What does the UN currently define as the
global poverty rate?
a. $1 a day c. $1.25 a day
b. $0.5 a day d. $2 a day

13.Which of the following is not a MDG?

a. Improve maternal health
 b. Achieve universal access to safe drinking water, sanitation and hygiene
c. Ensure environmental sustainability
d. Achieve universal primary education
14.According to the UN, which MDG has been achieved?
a. Reduce the maternal mortality rate by three – quarters
b. Halt and begin to reverse the spread of HIV – Aids
c. Reduce the under five mortality rate by two – thirds
d. Halve the number of people living in extreme poverty
15.Fill in the gap, MDG is to combat HIV – Aid, _________ and other diseases
a. Tuberculosis c. diarrhea
b. Malaria d. cholera

Self - Assessment
Before you end this Lesson 3, evaluate your current competency by answering the checklist their
follow. Put a check ( / ) mark to best describe your current level of mastery of each list competency.
Competency I can do I can do this but I I am learning I can not
this very need to learn how to do this do this yet
well more and improve (Apprentice) (Novice)
(Expert) (Practitioner)
What are the 8 MDGs?
What are the 17 SDGs?
Why are SDG important and need to
be studied?
Why are MDG important and need to
be studied?

Let’s Reflet!
1. Barometer Check. How can this Millennium Development Goals and Sustainable Development
Goals affect the Health Care Delivery System in the Philippines.
2. How does this COVID – 19 Pandemic affect the Poverty Rate in the Philippines?
3. Make a Cloud Concept about Millennium Development Goals?

Bibliography:
1. Frances Prescilla L. Cuevas, Jean P. Reyala, Rosalinda Cruz – Earnshaw, Shiela Bonito, Jean M.
Sitioco, Lorenza C. Serafica, 2007 Public Health Nursing

Suggested Readings and Websites:

1. https://www.youtube.com/watch?v=A5giOGjj5X8
2. https://www.youtube.com/watch?v=5G0ndS3uRdo
3. https://www.youtube.com/watch?v=_qLqLJq2954