Objectives: as np OnpPw Discuss how the World Health Organization (WHO) affects health issues in the Philippines, . Describe the Philippine Health Care Delivery System as to its components and sectors. . Differentiate the referral system from the interlocal health zone. . Distinguish the levels of healthcare, service and facilities, . Enumerate the various reform initiatives that shaped Philippine healthcare delivery. . Explain the salient features of the Universal Health Care Law in the Philippines.Anation’s health care delivery system has a tremendous impact not only the health of its people but also on their total development including their Socioeconomic status, Anderson and Mcfarlene (2011) emphasized the role of the following factors in shaping 21 century health that further influence health care delivery system: 1. Health care “reforms” 2. Demographics 3. Globalization 4. Poverty and growing disparities 5. Social disintegration tiWorld Health Organization (WHO)- specialized agency in the United Nations (UN) provides global leadership on health matter in the Philippines. Health services are provided by the; * government and ¢ private sector -for profit as well as non-profit to as Non- Government Organizations (NGO). On the national level, director is set by department of health (DOH) by virtue of mandate of the Local Government Code (R.A.7160) LGU's should have operating mechanism to meet the priority needs and service requirements of their communities. Basic Health Services are regarded as priority services for which LGU's are primary responsible.Health System consist of all organizations, people and actions whose primary intent is to promote, restore, or maintain health. 1. Service delivery 2. Health Workforce 3. Information 4. Medical Products, Vaccines, and technologies 5. Financing 6. Leadership and governance or stewardship i.The World Health Organization The WHO constitution came into force on April 7, 1948. Since then April 7 has been celebrated each year as World Health Day. Objective: attainment by all peoples of the highest possible level of health (WHO,2006) To attain its objective, WHO carries out the following core functions: + Providing leadership on matters critical to health and engaging partnerships where joint action is needed. WHO has 193 members of countries and 2 associate members. WHO and its members work with UN agencies, NGO's and the private sector. The WHO country focus is directed toward providing technical collaboration with member states with accordance with each country’s needs and capacities.Shaping the research agenda and stimulating the generation, translation, and disseminating valuable knowledge. The WHO strategy on research for health has 5 goals: Capacity- in reference to capacity-bullding to strengthen the national health research system Priorities — to focus research on priority health need particularly in low and middie income countries Standards - to promote good research practice and enable the greater sharing of research evidence, tools, and materials Translation - to ensure that quality evidence Is turned into products and policy Organization - to strengthen the research culture within WHO and improve the management and coordination of WHO research activities.© Setting norms and standards and promoting and monitoring their implementation. WHO develops norms and standards for various health and health -related issues, such as pharmaceutical products including vaccines and other biological products used in immunization, practices in maternal and child care, and environmental conditions. ¢ Articulating ethical and evidence-based policy options. Through its Department of Ethics and Social Determinants, WHO is evolved in various issues on health ethics. In collaboration with other governmental and nongovernmental organizations, WHO has worked on bioethical concerns such as those related to human organ and tissue transplantation, reproductive technology and public health response to threats of infectious diseases like AIDS, influenza, and tuberculosis.* Providing technical support, catalyzing change, and building sustainable Institutional capacity. WHO offers technical support training to its member countries in the fields of maternal and child health, control of diseases, and environmental health services, WHO is involved in monitoring the health situation and assessing health trends. WHO has developed guidance and tools and measurement, Monitoring and evaluation.The Philippines Is a member of a global system of nations interacting with each other at different levels and In different ways. Events that happen in other countries can affect the status of Filipinos. Ease of travel from ‘one part of the globe to another makes transmission of the communicable disease likewise easy. This has been proven by the events as the emergence and spread of disease like HIV/AIDS, SRAS (Severe Acute Respiratory Syndrome), AH1N1 influenza (swine flu) and COVID 19.In contrast, cooperation and sharing of resources among nations serve as the key in the solution of many human problems-health.WHO has worked as a partner of the Philippine DOH in the Development and provision of services towards the attainment of health-related Sustainable Development Goals (SDGs). The Sustainable Developmental Goals (SDGs) or Agenda 2030 aims to continue the gains achieved thru Millennium Development Goals (MDGs) implemented from 2000 to 2015. The SDGs contain 17 goals and 169 targets that will cover the period 2016 to 2030. In the Philippines, the Department of Health develops and aligns its programs to help achieve SDG 3 that focuses on ensuring health and well being of populations.THE PHILIPPINE HEALTH CARE DELIVERY SYSTEMComponents and Sectors of the Health Care Delivery System: The Philippine health care delivery system is composed of two sectors: (1) the public sector and (2) private sector. 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 for health. It has a regional office in every region and maintains specialty hospital, regional hospitals and medical centers. The public sector is largely financed through a tax based budgeting system at both national and local levels. In here, health is generally free at the point ofThe private sector is a largely market oriented and health care is rapid through users fee at the point of service. Its involvement in maintain the People’s health include providing health insurance, manufacturer of medicines, vaccines, medical supplies, equipment and other health and nutrition products, research and development, human resource and development and other health related services.The private sector is composed of for-profit and nonprofit agencies this sector provides all levels of services and accounts for a large segment of health service providers in the country. About 30% of Filipinos utilize private health facilities, Estimated 60% of national health expenditure goes to the private sector which employs more than 70% of the health professionals in the Philippines. Financing of health services is provided by three major groups: The government (national and local), private sources and social health insurance. The National Insurance Act of 1995 (R.A. 7875) created by the Philippine Health Insurance Corporation (PhilHealth). It is tax-exempt government corporation attached to the DOH for policy coordination and guidance, and aims for universal health coverage of all Filipino citizens.The DOH serves as the main governing body of health services in the country. The DOH provides guidance and technical assistance to LGUs through the center for health development in each of the 17 regions. O Provincial governments are responsible for administration of provincial and district hospitals. Q Municipal and city governments are in charge of primary care through rural health units (RHUs) or health centers. Satellite outposts known as barangay health stations (BHSs) provide health services in the periphery of the municipality or city.3 LEVELS OF HEALTH CARE 1. Primary-prevention of illness or promotion of health 2. Secondary-curative 3. Tertiary-rehabilitative1. Primary Level of Care (prevention of illness or promotion of health) a. The first contact between the community members and the other levels of health facility. 2. Secondary Level of Care (curative) a. Capable of performing minor surgeries and perform some simple laboratory examinations. 3. Tertiary Level of Care (rehabilitative) a. Complicated cases and intensive care requires tertiary care and all these can be provided.PRIMARY LEVEL SECONDARY LEVEL TERTIARY L Heal ion and Mness | Prevenifon of Complications Mine Early Prevention of Disability, etc. Prevention Dx and Tx Provided at - D When hospitalization is deemed | When highly-specialized medical > Health careRHU necessary and referral is made 10 care is necessary > Brgy. Health Stations emergency (now — district), | D> referrals are made to hospitals and Main Health Center provincial or regional or private medical center such as PGI, Community Hospital and Health hospitals PHC, POC, National Center for Center Mental Health, and other gov't DPrivate and Semi-private private hospitals at the municipal gen levelAccording to Increasing Complexity of According to the Type of Service the Services Provided Health Promotion, Preventive Care, | Health Promotion and | Information Dissemination Continuing Care for common | illness Prevention health problems, attention to psychological and social care, referals ‘Surgery. Medical services by | Diagnosis and Treatment | Screening Secondary Specialists ‘Advanced. specialized, diagnostic. Tert therapeutic & rehabilitative care POT4nr-aaes Medical Ce Teaching Training Hospitals Regional Health Services ict Hospitals Rural Health Unit Community Hospitals and Health Centers Private Practitioners. Puericulture Centers Barangay Health StationsMILLENNIUM DEVELOPMENT GOALSThe Millennium Development Goals On September 6 to 8, 2000, world leaders on UN General Assembly Participate in Millennium Summit. The result of the summit was a resolution entitled United Nations Millennium Declaration. In this declaration, the world leaders recognized their collective responsibility to uphold the principles of human dignity, equality and equity at the global level. The declaration expressed the commitment of the 191 member states, including the Philippines, to reduce extreme poverty and achieve seven other targets - now called the Millennium Development Goals (MDG's) by the year 2015. sThe following are the eight MDG’s and the targets corresponding to health-related MDG's 4,5, and 6: . Eradicate extreme poverty and hunger. . Achieve universal primary education. Promote gender equality and empower women. Reduce child mortality. Target: reduce by 2/3, between 1990 and 2015, the under-five mortality rate. . Improve maternal health. Target: . Reduce by three quarters the maternal mortality ratio . Achieve universal access to reproductive health6. Combat HIV/AIDS, malaria and other diseases. Targets: a. Have halted by 2015 and begun to reverse the spread of HIV/AIDS b. Achieve by 2010, universal access to treatment for all those who need it ©, . Have halted by 2015, and begun to reverse the incidence of malaria and other major diseases. 7. Ensure environmental sustainability 8. Develop a global partnership for developmentSUSTAINABLE DEVELOPMENT GOALS (SDEs)@) Sevecomnent GLIALS Poa ro Anson OU WOLDThe Sustainable Developmental Goals (SDGs) or Agenda 2030 aims to continue the gains achieved thru Millennium Development Goals (MDGs) implemented from 2000 to 2015. The SDGs contain 17 aspirational "Global Goals” and 169 targets that will cover the period 2016 to 2030.The Sustainable Development Goals (SDGs), aims to “ ensure that all human beings can fulfill their potential in dignity and equality and in a healthy environment.”+ The SDGs, otherwise known as the Global Goals, build on the Millennium Development Goals (MDGs), eight anti-poverty targets that the world committed to achieving by 2015. + The MDGs, adopted in 2000, aimed at an array of issues that included slashing poverty, hunger, disease, gender inequality, and access to water and sanitation. + The new Global Goals, and the broader sustainability agenda, go much further than the MDGs, addressing the root causes of poverty and the universal need for development that works for all people.Goal 1: End poverty in all its forms everywhere Lt} POVERTYGoal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture4 Sees Goal 3: Ensure healthy lives and promote well- being for all at all ages In the Philippines, the Department of Health develops and aligns its Programs to help achieve $DG 3 that focuses on ensuring health and well being of populations,GOAL 3. Ensure Healthy Lives and Promote Well being for all Ages TARGETS: * By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. * By 2030, end preventable deaths of newborns and children under § years of age, with all countries aiming to reduce neonatal Mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births * By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases one third premature mortality from non- communicable diseases h and well-being ce abuse, including narcotic drug abuse and harmful use of alcohol Sy 2020, halve the number of global deaths and i By 2030, ensure universal access to sexu, injuries from road traffic accidents fal and reproductiv including for fat lanning. P' /@ health-care services,Goal 4; Enst‘“- inclusive and quality education for all and promote lifelong learning CU cae NTGoal 4; Enst“** inclusive and quality education for all and promote lifelong learning QUALITY aan TI@: See GOALS Goal 5: Achleve gender equality and empower all women and girls GENDER TOA@zse cous Goal 6: Entre acess toate nd : 4 Sanitation for all ne a ResBien GOALS t H Goal 7; Ensure ~ “cess to affordable, reliable, | Sustainable and modern energy forall@z GOALS Goal 8: Promote inclusive and sustainable economic growth, employrin:,.and decent work for all a aA@p REAGOALS 7 CD Goal 9; Build resilient infrastructure, promote sustainable industnalization and foster innovation y INDUSTRY, INNOVATION SUE TAITWas Goal 10: Redv«e inequality within and among countries { anya INEQUALITIES = }@& QALS aa Goal 11: Make rss inclusive, safe, resilient and sustainable {| SISTA STS Ace@ssscls Pio) Goal 12: Ensure sustainable consumption and production patterns i RNR Ae AO UMTaSUGOALS Goal 13: Take urgent action to combat climate change and its impacts oct@eecws Goal 14: Conserve and sustainably use the oceans, seas and marine resources = coeWaa Goal 15: Sustainablv manage forests, combat desertification, halt and reverse lano degradation, halt biodiversity lossALS Goal 16: Promote ‘ist, peaceful and inclusive societiesa Sustainable Developmental Goals (SDGs) It is a whole system;approach to improving-health = system performance and sustaining health gals. It focuses on attention on people and communities, calling for health systemsithat are of good quality, efficient, equitable, accountable, . resilient and responsive to the needs of diver’s: population groups, including in particular those left furthest behind. i—— Goal 17: Revitalize the global partnership for sustainable de. 2lopment | PE ce MUAH TRSInformed about the goals and engaged in through the p = PY $ G children and youth, indigenous peo local authorities, workers and farmers. me ‘ Bie a eee se | The Global Goals require the inclusion of local sustainable. Moreover, the: Very definition of si focus on children and youth. fs sl _ RePHILIPPINE ~ DEPARTMENT OF HEALTHThe Department of Health The DOH is the national agency mandated to-lead ‘he health Sector towards assuring quality health care for all Filipinos. DOH Vision: is to make ‘Filipinos among the healthiest in Southeast Asia by 2022 and in Asia by 2040" { DOH Mission: “To Lead the country in the development of a productive, resilient, equitable, and People centered. health system’ | (DOH,2019).Department of Health Framework for Implementation of Health Reform: FOURMm«la One Plus “454 Plus) _ GOALS: The FOURMmula ONE Plus(F4) for Health airs nt 1. Better Health Outcomes 2. More Responsive Health System 3. More Equitable Health Care Financing” STRATEGIC PILLARS: “inancing, Service Delivery, Governance and Regulation “PLUS” Performance Accountability VALUES : Integrity, Excellence and CompassionDOH has the feist major roles: | 1, Leader in health T coe 2. Enabler and capacity builder : 3. Administrator of specie seriesROLES and Functions of the DOH 1. Leadership in Health elucidated in Executive vc following functions; research, training and services = Q Advocating for health promotion and healthy QO Serving as technical hority in disease control 2 Q Providing administrative and technical leadershiROLES and Functions of the DOH 2. Enabler and Capacity Builder OProviding logistical support to LGUs the private seutor and other agencies in implementing health programs «and services; OServing as the lead agency in health and medical research Protecting standards of excellence in training and education of health care providers at all levels of the health care system.ROLES and Functions of the DOH 3. Administrative of Sr“cific Services O Serve as administrator of selected health facilities at subnational levels that act as referral centers for ja health system, Q Provide specific program components for conditicrs that affect large segments of the: populations U Develop strategies f-- responding to emerging health needs O Provide leadership in health emergency preparedness and response services, including referral and networking systems for traiima_ initiriasThe DOH core va’. 4s reflect adherence to the hignest standards of work namely: (1.) Integrity (2.) Excellence (3.)Compassior and respect for human dignity (4.) Commitment (6.) Professionalism: (3:)Teamwork. (7.), Stewardship of the health of the people (DOH, 2013). : The DOH carries out its work through the various certral bureaus and services in the central office, Center for Health Development (CHD) in every fegion, DOH- attached agencies, and DOH-retained hospitalsZi jane 1698 Emilio Aguinaldo, General Orders No. 15. 1698 —1905 Edie as the first Commissioner of Public Health. i, eation of tw Deparment of Public. Works, ' Jocation Hygiene (row the Department of Public (Works &, Highways Department of Education Culture & Sports, and bc sunment’ of Health, respectively) through the Proclamation) 0’ President Zi September 1896 | Est... iment of the Board of Heath for the City of \ianiia under! Abolition of the Board of Health and appolstment'ei tr: Guy L. +. ——, Act No. 167 of the] creation of the Board of Health for the PHippine 2 nds; |t also acted as the Board cf Health for the ity of Maria division of the bands. also tha | Were taken over by the Bureau of Health Reorganization Act | the Office of the Distict Health Officer ‘Acts Nos. 307, 308 | Establishment of the Provincial and Municipal Bows of Health, ‘completing the health organization In accordance with ‘he temitorial t No. 1407 ‘AbolNon of the Board of Health and:its functions avd actives) | Passage of Act No. 1487 of the Philippine Commis on repealing | Act No. 307 wherein the provincial Board of Health gave way 10une reaton of th iment 0 Oy : Hygiene (now the Department of Public © Department of Education Culture & Sports, ; | 28 September 1698 i 169° 1905 ‘Act No. 167 of the PhilippineChanging of the name of the Bureau of Heals __| Health Service, which was lar on changed os fmDepanme: was under te Secretary of Heath ind Pula Welfare and’also inched the Bureau of Quarantine the heat department of chartered cies: the provincial. city a! hospitals; dispensaries and clirics, the pubic muijets and Slaughter houses; the health resorts; and al chartlasiv und reiet agencies. However, tho. Philippine General Hopital was detached from the nt and tranaterred fo, 1 (318ce of the President of the Prisy/pines. a Reorganization of government offices under Exaciti-x Order No. 94, series of 1947 WM the Uanstor of ine. Buea of Pubic Weltare to the Office of the President and the Department was, renamed Department of Health (DOH).Under ti setup were he follow. Under Executive Order No, 392, 8. 1950, the Cienarment of Healin gained additional functions brought about by te tansior ‘of the Instiide of Nutilion, together with the Divisioc: of Biological Research and the Division of Food Technology from the istite of Science, and the Pubic Schools Medical anti Den'al Services from ine Office of the President of the Philippines ai< the Bureau of Public School respectively to the DOH. Witin th Oepartment of Health, certain changes were also effected thru t-«- transfer of {he Division of Health Education and Information fron the Bureau of Heath to the Department proper, in exchange ‘o- wtich the: ‘drug Inspection Division was tansferred to the forme: office from the fatter: the conversion of the Section of Tuber-ubsis into @ Division of Tuberculosis, directy under the Citco of the Secrotary. and the conversion of the Division of Labo-atories Into ‘an Office of Public Health Research Laboratory.Of January 1944 Passage vi Act. No. 2156, s0- called “Fajardo Act", wich’ aulhorized the consoldation. of municipaflies.'i)~santary ‘division and established what is now known as the "}ealth Fund" Changing of the name of the Bureau of Health to Ine Philippine | = Health Service, whizh was laler on changed to. its former name. Passage of Act No, 4007, also “the Reorganization Act of 1932", which crealed the Office of the Cortmissioner of Health and Public Wolfare, the Philippine General Hospital, and the five examining boards (medical, pharmac>:Aicl, denial, ‘optical and nursing): Creation of the Department of Health and Public Welfare as provided for in Executive Order No. 317, series of 1941. TheTegional Unserascrotaes of Heat th Undersecretary of haath and te Medical Servces and the Undersecretary of Speci’ Zerices. 1971 The creation of the Food and Orug Saad ‘Bureau ‘Of Disease inieligence Center, Malaria Eradicatz- Service. Bureau of Dertal Health Service, the National: Coiry rehensive Materal and Child Heatvi / Family Planning Progritr, National Nutrition Program, and the National Sctistosomnlis. Control ‘Commission, among others. Through “Hier of Implementation No. 8, “pusuant Presidential Decree No, Sept24, 1972, the JOH was renamed Ministy of Health. The National Cancer’ Center and Radiation Heath Senice were crealed. The Mristy wis divided indo 12 regions covering several provinces and cies under a regional heath direclor, Atached offices were. th: Philppine Medical Care Commission, the Dangerous Drucs Board, National Nutiion Council, Popaton Commission, .Natonal Schistosomiasis. Control Council and the Tonic General Hospital1982 1386 7 Under Execi ve Order No. 851, the Hesith Education and, Manpower Development Service was created. and the Bureau of, Food and Drugs assumed the functions of tr) Food and Drug Administration, ® ‘The Ministry of Health bacame Department of Health again. 13987 Another re-organization under Executive Order No. 119, whi placed under the Secretary of Health five offices headed by an. undersecretary and an assistant secretary. Thase offices are the Chief of St. 4 Public Health Services, Hospital and Facilities ‘Services, Standard and Regulations, and Mangement Service. Full implementation of Republic Act No. 7160 or Local Government Gode. The DOH changed its \role from one of implementation to one of govemance. Significant change: branching out of the Office of the Public Hei'h Services fo form the Office for Special Concems. Two big offices merged to become the Office of Hospital Facilities, Standards “and Regulation. Special: projects were highlighted like the NID. National Micronutrient Campaign, Disaster ‘Management, Urban Health and Nutrition Project, Traditional Medicine, Doctors to the Barrios Program, “Let's DOH tt"! became a national battle cry.2007 fh Juy 12, 2001, Administrative Order 37 whicn contained: the guidelines on the operationalization of the HSRA. iiplementation plan was signed by Sec. Manual Dayrit. Wis also (ting this year that the 13 convergence siles or the advance ‘mplementation areas have been estabished. ee The One-Script Systems improvement Program as established {AO 50. S. 2003) 16 orchestrate unity, synchronicity and focused targeting of priority public heath programs that would provide the biggest Impact to attaining equity, efficiency, acccss and quality health care in the couniry. A major breakthrough was achieved in providing fiscal aulonomy to 68 DOH retained ho spita's with the | approval of a special provision of FY 2003 GAA which authorized 100% retention and the use of hospital income fur upgrading of health facilities and services. 2005 FOURmua ONE for Health (F1) was launched as the health sectors. blue print for the implementation of reforms to bring about better health outcomes, more responsive health system and more equitable healthcare financing. Province-wide Investment Plans for Health were developed in 16 provinces asComuplion. DOH also topped in the Puse Asia 3rd Quaiter Suney as the number one goverment agency in lems of overall performance,Local Health System and Devolution of Health Services« R.A 7160 of Local Government Code was enacted to bring about genuine and meaningtul local autonomy. This will enable local governments to attain their fullest development as self-reliant communitios and make them more effective partners in the attainment of national goals. » Devolution relers to the act by which the national government confers power and authority upon the vanous LGU's to perform specific functions and responsibilities, . R.A 7160 provided for the creation of the Provincial Health Board and the City/Municipal Health boards, or Local Health Boards. © The chairman of the board Is the local executive- the Provincial Governor!hair: Mayorchaicman of tho local health boardMembers of the board are composed of the chairman of the committee on health of the Sanggunian, a representative from private sector or NGO involved in health services, and a representative of the DOH. The functions of local health boards are as follows: 1. Proposing to the Sanggunian annual budgetary allocations for the operation and maintenance of health facilities and services within the provincelcity/municipality; 2. Serving as an advisory committes to the Sanggunian on health matters; and 3. Creating committees that shall advise local health agencies on various matters elated to health service operations.The Rural Health Unit : The RHU, commonly known as health center, is a primary level health facility in the municipality, The focus of RHU is preventive and promotive health services and the supervision of BHSs under its jurisdiction. The recommended ratio of RHU to catchment population is 1 RHU: 20,000 Populations, The BHS Is the first contact health care facility that offers basic Services at the barangay level. It is a Satellite station of the RHU. It is Manned by Volunteer Barangay Health Workers (BHW's) under the Supervision of Rural Health Midwife (RHM).The Rural Health Unit Personnel The Municipal Health Officer (MHO) or Rural Health Physician heads the health services at the municipal level and carries out the following Toles and functions: 1. Administrator of the RHU a. Prepares the municipal health plan and budget b. Monitors the implementation of basic health services c. Management of the RHU staff2. Community physician a) Conducts epidemiological studies b) Formulates health education campaigns on disease prevention C) Prepares and implements Control measures or rehabilitation plan 3. Medico-legal officer of the municipality, The revised implementing rules and regulations (IRRSs) of RA. 7305 or the Magna Carta of Public Health Workers Stipulate that there be one rural health physician to @ population of 20,000The Rural Health Unit Personnel The Public Health Nurse (PHN): : 1. Supervise and guides all RHMs in the municipality. 2. Prepares the FHIS (Field Health Service Information System) quarterly and annual reports of the municipality for submission to the Provincial Health Office. 3, Utilize the nursing process in responding to health care needs, including needs for health education and promotion of individuals, families and catchment community. 4. Collaborate with the other members of the health team, government agencies, private business, NGO's and people organizations to address the community's health problems. = gif =m* With limitations of LGUs to finance health human resource, the DOH has launched Nurse Deployment Project (NDP) to augment efforts of PHNs in their areas of jurisdiction. aThe Rural Health Unit Personnel The Nurse Deployment Project: One of the projects under the Department of Health (DOH) Deployment Program that aims to deploy, community-oriented and dedicated nurses fo difficult areas. Notably, the project aims to achieve the following: QAugment the nursing workforce in the Rural Health Units/Birthing Homes and Barangay Health Stations thus provide access to health services for the Targinalized population; OProvide employment and work experience for nurses in rural areas and underserved communities and Q Address the proliferation of the so-called ‘volunteer nurses for a fee" (.e., working in hospitals without being paid, albeit, they themselves pay the hospital to obtain a certificate of work experienceProject Description: * Deployment of registered nurses for the improvement of local health systems and support to the attainment of Universal Health Care or Kalusugan Pangkalahatan « Nurses shall be hired under contract of services with a position of Public Health Nurse Il. Contract for six 6) months that can be renewed based on a very satisfactory » Assignment in priority areas covering 1,491 municipalities, 143 cities and 13 districts of Metro Manila giving preference to 44 Focus Geographical Areas (FGA), Accelerated Sustainable Anti-Poverty Program (ASAP), Whole of Nation Initiative (WNI) « Afler satisfactory completion of the project, the Nurses are awarded with a Certificate of Completion and EmploymentFUNCTIONS: * Focus on assisting PHNs in Implementing programs, health education, and preparation of reports, * Conducts regular Visits to pnority households under the National Household Targeting ‘System for Poverty Reduction (NHTS-PR) «Prepares heaith status reports of familles based on the NHTS-PR prionty households * Plans for appropriate interventions on the identified health concems of families under the priority NHTS-PR = Assists in the conduct of regular monitoring and evaluation of various health programs under the NHTSPR " Focus on assisting PHNs in implementing programs, health education, and preparation ofSalaries and Benefits: + Public Health Nurse Il - Salary Grade 15 + Monthly Salary of Php 32,747.00 for 2017 2nd tranche of the Salary Standardization Law 4 + Enrollment to PhilHealth Insurance + Enrollment to GSIS Personal Group Accident Insurance * Local/Regional Trainings (ie, Orientation on Disease Surveillance, Family Planning Counselling, etc. )The Rural Health Unit Personnel The Rural Health Midwife (RHM) or Public Health Midwife: 1. Manages the BHS and supervise and trains the BHW; 2. Provides midwifery services and executes health care programs and activities for woman of reproductive age, Including family planning counselling and services. 3. Conducts patient assessment and diagnosis for referral or further Management; 4, Perform health information, education and communication services 5. Organize the community 6. Facilitates barangay health planning and other community services.The Rural Health Unit Personnel + The Rural Sanitation Inspector are directed towards ensuring a healthy physical environment in the municipality, This entails advocacy, monitoring and Teguiatory activities such as Inspection of water supply and unhygienic household conditions. * Barangay Health Worker (BHW) considered as the interface between the community and the RHU. They are trained in the preventive health care, with a strong emphasis on matemal and child care, family planning and reproductive health, nutrition and sanitation. > BHWs are accredited by the local health board according to DOH guidelines. > RA 7883 or the Barangay Health Workers Benefit and Incentives Act entitles them to hazard and substance allowance and other benefits.DOH Recommendations for Human Resource for Health and Health Facilities Ratlo to Population 1 RHU/ HC Physician: 20, 000 Population Ratio 1 Public Health Nurse: 10,000 Population Ratio 1 Public Health Midwife: 5,000 Population Ratio 1 Public Dentist: 50,000 Population Ratio 1 RHU(Rural Health Unit): 20,000 Population Ratio 1 BHS (Barangay Health Station): 5,000 Population RatioClassification of Health Facilities (DOH AO - 2012-0012 )Levels of Health Care Services and Facilities The DOH issued Administrative Order 2012-0012 (Rules and Regulations Governing the new Classification of Hospitals and Other Health Facilities In the Philippines) that provides for a new classification scheme of health facilities,NEW CLASSIFICATION ® OTHER HEALTH GENERAL [A Prmarcareracity | = Level1 = Level3 (Teaching/ |C. —_eo Training) D. Sor eaGn BAe SPECIALTY FacilityDOH administrative Order 2012-0012 classifies other health facilities as follows: " Category A. Primary Health Care Facllity - a first contact health care facility that offers basic service including emergency services and provision for normal delivenes. 1. Without in-patient beds like health centers, out-patient clinics, and dental clinics. 2. With in-patient beds — a short-stay facility where the patient spends on the average of one to two days before discharge. Ex Infirmaries and birthing (Lying-in) facilities.Category B. Custodial Care Facllity - a health facility that provides long- term care, including basic services like food and shelter, to patients with chronic conditions requiring ongoing heallh and nursing care due to impairment and a reduced degree of independence in activities of daily living, and patients in need of rehabilitation. Exc Custodial health care facilities, substance/drug abuse treatment and tehabilitation centers, sanitaria, leprosana, and nursing homes.Category C. Diagnostic/Therapeutic Facility - a facility for the examination of the human body, specimens from the human body for the diagnosis, sometimes treatment of disease or water for drinking analysis. The test covers the preanalytical, analytical and post analytical phases of examination. This category is further classified into: 1. Laboratory Facility, such as, but not limited to the following: a) Clinical laboratory b) HlVitesting laboratory ¢) Blood service facility d) Drug testing laboratory e) Newbom screening laboratory AL ahnratans far drinabina watar analucic2. Radiologic facility providing services such as X-ray, cT scan, mammography, MRI, and ultrasonography. 3, Nuclear medicine facility- a facility regulated by the Philippine Nuclear Research Institute utilizing applications of radioactive materials in diagnoses, treatment, or medical research, with the exception of the use of sealed radiations sources in radiotherapy as in internal radiation therapy.Category D. Specialized outpatient facility - a facility that performs highly specialized procedures on a outpatient basis. Ex: Dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic center/clinic, cancer radiation facility, and physical medicine and rehabilitation center/clinic.The Inter-Local Health Zone « An Inter Local Health Zone (ILHZ) Is defined fo be any form of organized arrangement for coordinating the operations of an array and hierarchy of the health care providers and facilities, which typically includes primary health care providers, core referral hospital and an end referral hospital, jointly serving a common population within a local geographic area under the junsdictons of more than one local goverment. » ILHZ, as a form of inter-LGU cooperation is established in order to better protect the public or collective health of their community, assure the constituents access range of services necessary to meet health care needs of individuals, and to manage their limited resources for health more efficiently and equitably.The Inter-Local Health Zone © The Inter Local Health Zone (ILHZ) functionality is defined mainly by observable zone wide health sector performance results in term of: 4. Improved the health status and coverage of public health intervention of the Zone population. 2. Access by everyone in the zone to a qualify care; 3. Efficiency in the operations of the inter-local health services.« The referral system functioning within the context of the Inter-Local Health Zone (ILHZ) provides a means for consolidating health care efforts. * The ILHZ is based on the concept of the District Health System, a genenc term used by WHO to deseribe an integrated health management and delivery system based on a defined administrative a geographical area. « AnILHZ has a defined catchment population within a defined geographical area, it has a central or core referral hospital and a number of primary level facilities such as RHUs and BHSs.The ILHZ has the following components: . © People, Although WHO has described the Ideal population size of a health district between 100,000 and 500,000, the number of people may vary from zone to zone, especially when taking Into consideration the number of LGUs that will decide to cooperate and duster, © Boundaries. Clear boundaries between ILHZs establish accountability and responsiblity of health service providers. © Health facilities. RHUs, BHSs, and other health facilities that decide to work together as an integrated health system and a district or provincial haspftal, serving as the central referral hospital. © Health workers. To deliver comprehensive services, the ILHZ health workers include personnel of the DOH, district or provincial hospitals, RHUs, BHSs, private clinics, volunteer health workers from NGOs, and community based organizations.« Internal referrals — occur within the health facility; may be made to request for an opinion or suggestion, comanagement, or further management or specialty care. » External referral - is a movement of a patient from one health facility to another. It may be vertical, where the patient referral may be from a lower to a higher level of health facility or the other way round.The Health Referral System « Areferral is a set of activities undertaken by a health care provider or facility in response to its inability to provide the necessary health intervention to satisfy a patient's need. « A functional referral system is one that ensures the continuity and complementation of health and medical services. « Itusually involves movement of a patient from the health center of first contact and the hospital at first referral level. © When hospital intervention has been completed, the patient is referred back to the health center. This accounts for the term two-way referral system. « Referrals may be intemal or externalREFERRAL SYSTEM: BHS— RHU-> MHO— PHO RHO— National Agencies Specialized AgenciesHealth Sector Reform: * FOURmula One Plus (F1 Plus) is the latest in’ aseries of continuing efforts of the goverment to bring about health sector teform covering to 2017 to 2022. » Fi Plus was built upon strategies of two previous platforms of reform: FOURmula One (F4) for health (2005-2010) and Kalusugan Pangkalahatan or Aquino Health Agenda (2011-2015.) « Administrative Order 2018-0014 entitled “Strategic Framework and Implementing Guidelines for FOURmula One Plus (F1 Plus) for Health.Health Reform Framework in the DOH from 2005 to 2022.| FOURMULA 1+ lf i DEPARTMENT OF HEALTH | ape feceat olpuesang paaiee | Sr amnoa ra kitam v9 fi|" Logeal Frameworks The FOURmula | One Plus for Health (F4Plus for Health) | isthe blueprint of the health sector Plans and commitments for the medium term, The F4Plus for Health Strategy Map @@ B Multisectoral collaboration: |The Overarching goal of providing Universal Health Care (UHC) can only be achieved through the collective efforts of all stakeholders. Dea5UNIVERSAL HEALTH CARE (UHC), ALSO REFERRED TO AS KALUSUGAN PANGKALAHATAN (KP). * The Aquino administration puts it as the availability and accessibility of health services and necessities for all Filipinos. * Itis a goverment mandaie aiming to ensure that every Filipino shall receive affordable and quality resources - health human resources, health facilities, and health financing. « UHC law (Republic Act 11223) guarantees each Filipino citizen access to healthcare services that are either individual-based or population based,UHC’S THREE THRUSTS 1) Financial risk protection through een in enrollment and benefit delivery of the National Health Insurance Program (NHIP); 2) Improved access to quality hospitals and health care facilities; and 3) Attainment of health-related Millennium Goals (MDGs).PHILIPPINE HEALTH AGENDA (2010-2022)