CHAPTER 12 (2) health workforce

PHILIPPINES HEALTH CARE DELIVERY (3) information

SYSTEM (4) medical products, vaccines, and
technologies;
(5) financing;
□ OVERVIEW OF THE HEALTH CARE (6) leadership and governance or stewardship
DELIVERY SYSTEM (WHO, 2007a).

A Nation's health care delivery system has a tremendous • The Nurse is an essential member of
impact not only on the health of its people but also on the health workforce in the country.
their total development, including their • For the nurse to work efficiently within the health
socioeconomic status. care delivery system, an understanding of the
dynamic relationships among its components is
A discussion of the health care delivery system often needed.
involves issues of cost and challenges
. Nations go For example, a nurse who understands the referral
through a struggle to overcome multiple forces in system will be able to refer patients to the
efforts to advance the nation's health within the appropriate facility or health personnel.
context of their financial and political situations.

Anderson and McFarlane (2011) emphasized the role □ WORD HEALTH ORGANIZATIONS
of the following factors in shaping 21st century health
that further influence health care delivery system: ✓ I United Nations in 1945 Discussed
(1) health care "reforms," the creation of a global health organization.
(2) demographics, ✓ The World Health Organization was the
(3) globalization, outcome of these discussions.
4) poverty and growing disparities, ✓ The WHO constitution came into force on
(5) social disintegration. April 7, 1948

This chapter delineates the health care delivery system
in the Philippines, beginning with the World Health
Organization (WHO), as this specialized agency in the
United Nations (UN) provides global leadership on
health matters in the Philippines.
Health services are provided by the Government and
Private sector for profit and non-profit.
• On the National Level direction is set by the
DOH ).
• By virtue of the Mandate of republic act 7160
Local government units (LGU) employ operating
mechanisms to meet their community needs and
service requirements of their communities.
• Basic health services are regarded as
priority services, for which LGUs are primarily
responsible. A health system consists of all
organizations, people, and actions whose primary
intent is to promote, restore, or maintain health.
• A Health system has six building blocks or components
(1) service delivery
• WHO constitution states that its objective is the
Attainment by all people of the highest possible level
of health (WHO, 2006).
• To attain it obiective, WHO carries out the Following
Core functions (WHO, 2013b):
1. Providing leaderships on matters critical
to health and engaging in partnerships where
joint action is needed.
Notes: WHO and its members work with UN
agencies, NGOs, and the private sector
(WHO, 2006).
2. Shaping and Research Agenda and
stimulating the generation, translation and
disseminating valuable knowledge.
• Five Goals of Research Strategy by WHO:
1. Capacity
2. Priorities
3. Standards
4. Translation
5. Organization
3. Setting Norms and promoting and monitoring
their implementation

1|Page

4. Articulating ethical and evidence-based
policy options.
5. Providing technical support, catalyzing
Change, and building sustainable institutional
capacity.
• The Philippines is a member of a global system of
nations interacting with each other at different
levels and in different ways.
• Evens that happen in other countries can affect the
health status of Filipinos.
Ex. Ease of travel from one part of the globe to another
makes transmission by of communicable diseases
likewise easy.
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 Development Goals (SDGs) or
Agenda 2030 aims to continue the gains achieved
thru the 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 population
□ HISTORY OF PHILIPPINE HEALTH CARE
DELIVERY SYSTEM
• Public health services in the Philippines date back
to the Spanish regime.
2|Page
• In 1577, Franciscan Friar Juan Clemente
opened a medical dispensary in Intramuros (the
old walled city of Manila) for the indigent.
• In 1690, Dominican Father Juan de Pergero
worked toward installing a water system in San
Juan del Norte (now San Juan City, Metro Manila)
• Manila Smallpox vaccination was introduced by
Dr. Francisco de Balmis, the personal
physician of King Carlos IV, who came to the
Philippines in 1805."The first Medicos Titulares
were appointed by the Spanish Government
in1876.
• The Medicos Titulares worked as
provincial health officers.
✓ A 2-year program consisting of fundamental
medical and dental courses was first offered
in the University of Santo Tomas in 1888.
✓ Graduates of this program known as
Cirujanos Ministrates served as male nurse
and sanitation inspectors.
• In 1901 , the United States Philippine
Commission, through Act. 57, created the Board
of Health of the Philippine Islands, with a
Commissioner of Public Health as its chief
executive officer.
✓ The board of health eventually evolved into
what is now the Department of Health.
Subsequently, provincial and municipal
boards of health were formed.
• The Fajardo act of 1912 created sanitary divisions
made up of one to four municipalities.
• Each sanitation division had a "president" who
had to be a physician.
• Usually, there would be a sanitation inspector
and, sometimes, a nurse.
• 1915, the Philippine General Hospital began to
extend public health nursing services in the homes
of patients by organizing a unit called Social
Home Care Service, with two nurses as staff.
• Puericulture center nurses carry out health
educational activities and visits to follow up cases
and invite client to consult at the center.
Founded by the Association Feminista Flipina in 1905.
• La Gota de Leche was the first center
dedicated to service of mothers and babies.
• In 1947 the Department of Health
was reorganized into bureaus; quarantine,
 hospitals that took charge of municipal and • The largely financed through a
charity clinics, and health with sanitation tax-based budgeting system at both national and
divisions under it. local levels.
The reorganization also placed the administration of • The local health system is now run by
city health departments at the bureau level.
• In 1954 , Congress passed R.A. 1082 or the • provincial) and district hospitals are under the
Rural Health Act that provided for the creation of provincial governments.
rural health units in every municipality.
Furthermore, R.A. 1082 provided for the • City/Municipal Government Manages Health
employment of physicians to serve as municipal Centers/ Rural health Centers (RHU) and
health officers, public health nurses, midwives, Barangay Health Stations (BHSs).
and sanitary inspectors in these facilities.
• In Care Delivery
1970's, the Philippine Health
System was □ DEPARTMENT OF HEALTH
restructured, paving the way for the health care
system that exists to this day where health • Vission:
services are classified into primary, secondary
• Mission:
and tertiary levels.

TERTIARY
1. National Hospitals
2. National Medical Centers and National
Specialized Hospitals
3. Regional Hospitals / Regional Medical Centers
4. Teaching and Training Hospitals
SECONDARY
1. Provincial Health office
2. District Hospitals
3. Emergency Hospitals
4. Provincial Hospitals/ Provincial medical centers
PRIMARY
1. Municipal health office
2. Rural health Units
3. Health Centers
4. Barangay Health Stations
□ COMPONENTS AND SECTORS OF THE
HEALTH CARE DELIVERY SYSTEM
• The Philippine health care delivery system is
composed of agencies, personnel and services
divided in two sectors: public and private.
• The consists of the l
and providing health services.
• At the national level, the
mandated as the lead agency or health.
• It has a regional office in every region and
maintains specialty hospitals, regional hospital,
and medical centers.
• It also maintains provincial health teams made up
of to the local health
boards and personnel involved in communicable
disease control, specifically for malaria and
schistosomiasis.
DOH MANDATES:
• National agency mandated to lead the health
sectors towards assuring quality health care for all
Filipinos.
• The major mandate of DOH is to provide national
policy direction and develop national plans,
technical standards and guidelines on health.
• It is also a regulator of all health services and
products; and provider of special or tertiary health
care services and of technical assistance to other
health providers specially to Local Government
Units (LGU).
• With other health providers and stakeholders, the
DOH shall pursue and assure the following:
✓ Promotion of the health and well-being for
every Filipino;
✓ Prevention and control of diseases among
population at risk;
✓ Protection of individuals, families and
communities exposed to health hazards &
is
risks; and
✓ Treatment, management and rehabilitation of
individuals affected by diseases and
disability.
Based on Executive Order 102, issued by the
Office of the President in May 24, 1999, the
DOH is responsible for and serve as the:
1. Lead agency in articulating national objectives
for health, to guide the development of local
health systems, programs and services;

3|Page
 2. Direct service provider for specific programs 15. Implementer of the National Health Insurance
that affect large segments of the population, Law; providing administrative and technical
tuberculosis, malaria, schistosomiasis, HIV- leadership in health care financing; and
AIDS and other emerging infections and 16. Expressing national objectives for health to
micronutrient deficiencies; lead the progress of local health systems,
3. Lead agency in health emergency response programs and services.
services, including referral and networking
systems for trauma, injuries and catastrophic • In the persuit of its Mission and Vission DOH has
events; the following major roles:
4. Technical authority in disease control and 1. L
prevention; 2. E
5. Lead agency in ensuring equity, access and 3. A
quality of health care services through policy
formulation, standards development and To accomplish its mandate and roles the
regulations; Department has the following power and
6. Technical oversight agency in charge of functions based on Executive Order 102. Series
monitoring and evaluating the implementation 1999:
of health programs, projects research, training 1. Formulate national policies and standards for
and services;
7. Administrator of selected health facilities at
sub-national levels that act as referral centers
for local health systems i.e., tertiary and
special hospitals, reference laboratories,
training centers, centers for health promotion,
center for disease control, and prevention,
regulatory offices among others;
8. Innovator of new strategies for responding to
emerging needs;
9. Advocate for health promotion and healthy
life styles for the general population;
10. Capacity-builder of LGUs, the private sector,
non-governmental organizations, people’s
organizations, national government agencies
in implementing health programs, services,
through technical collaborations, logistical
health;
support, provision of grants and allocation and
2. Prevent and control leading causes of death
other partnership mechanism;
and disability;
11. Lead agency health and medical research;
3. Develop disease surveillance and health
12. Facilitator of the development of health
information systems;
industrial complex in partnership with the
4. Maintain national health facilities and
private sector to ensure self-sufficiency in the
hospitals with modern and advanced
production of biologicals, vaccines and drugs
capabilities to support local services;
and medicines;
5. Promote health and well-being through public
13. Lead agency in health emergency
information and to provide the public with
preparedness and response;
timely and relevant on health risks and
14. Protector of standards of excellence in the
hazards;
training and education of health care providers
6. Develop and implement strategies to achieve
at all levels of the health care system;
appropriate expenditure patterns in health as
recommended by international agencies;

4|Page
 7.Develop sub-national centers and facilities for
health promotion, disease control and
prevention, standards, regulations and
technical assistance;
8. Promote and maintain international linkages
for technical collaboration;
9. Create the environment for the development of
a health industrial complex;
10. Assume leadership in health in times of
emergencies, calamities, and disasters and
system failures;
11. Ensure quality of training and health human
resource development at all levels of the health
care system;
12. Oversee financing of the health sector and
ensure equity and accessibility to health
services; and
13. Articulate the national health research agenda
and ensure the provision of sufficient
resources and logistics to attain excellence in
evidenced-based intervention for health.
• To perform these functions are the various
central bureaus and services and sixteen (16)
field offices called Centers for Health
Development in every region including
specialty hospitals and regional hospitals and
medical centers.
• It also has provincial health teams made up of
DOH representatives to local health boards and
technical personnel for communicable disease
control.
Figure 1: DOH Performance Governance
System Framework
• LOCAL HEALTH BOARDS
• L
Was enacted to bring genuine and meaningful
local Autonomy.
• Local Governments to attain their fullest
development as self-resilient community and
make them more effective partners in the
attainment of national goals.
• LGU to
• R. Provided for the creation of
the provincial Heath boards and the city/
municipal health boards or Local health
Boards.
5|Page
Functions of local Health boards:
1. Proposing to the
for the operation and maintenance
of health facilities and services within the
province, city, or municipality.
2. Serving as an
to the Sanggunian on health matters.
3. Creating committees that shall advise local
health agencies on various matters related to
health service operations.
• THE RURAL HEALTH UNIT AS
PERSONNEL
• Rural health unit (RHU) commonly known
• Primary level health facility in the
municipality.
• FOCUS:
health services and the supervision of BHSs
under its Jurisdiction (DOH, 2001)
• B is
that offers basic services at the barangay level.
• Manned by
under the supervision of the
A. Municipal Health Officers or
Head the health services at the municipal level and
carries out the following roles and functions:
1. A
2. C
3. M
B. Public Health Nurse:
1. Supervise and guides all RHMs in the
municipality (DOH, 2001)
2. Prepares the FHSIS quarterly and annual
reports of the municipality for submission
to the
3. Utilize the nursing process in responding
to health care needs for health education
and promotion of individuals, families,
and catchment community.
4. Collaborates with the other member of
health care team.
The DOH
to augment efforts of PHN in their areas of
jurisdiction.
 C. Rural Health Midwife or Public health an array and hierarchy of health providers and
midwife: facilities.
1. Manages and supervises and • Describe an intergrated health management and
train BHW. delivery system based on a defined
2. Provide Midwifery services and administrative and
including family planning. • This includes: ,
3. Conduct and assessment and refer for
further management. • Inter- Cooperation in order to better
4. Perform Health information protect the public or collective health of their
5. Organize the community community.
6. Facilitates barangay health planning. • One for the people
D. B living in LGU that are coordinating with one
• Are considered as the interference between the another.
community and the RHU. • One to its individual
residents and to the zone population as a whole.
DOH recommendation for human resources
• I :
for health and health facilities ratio to
1. Improved health status and coverage of
population
public health intervention of the zone
1 RHU/HC 20,000 population
population.
physician ratios
2. Access by everyone in the zone to the qualify
1 PHN 10,000 Population
care. And
Ratio
3. Efficiency in the operation of inter-local
1 PHM 5,000 Population Ratio health services.
1 PHD 50,000 Population
Ratio ILHZ Components
1 RHU 20,000 population
□ P
Ratio
□ B
1BHS 5,000 Population Ratio
□ Health Facilities
□ H

□ LEVELS OF HEALTH CARE-SERVICES

AND FACILITIES
• DOH (Rules
and Regulations Governing new classification of
Hospitals other health facilities in the
Philippines.)

CATEGORY A: P

CATEGORY B: C

CATEGORY C: D

CATEGORY D: S

□ INTER LOCAL HEALTH ZONE

• Defined to be any form of organized
arrangement for coordinating the operations of

6|Page
 □ HEALTH REFERRAL SYSTEM • This approach shall strengthen the National
• Referrals occur maybe Health Insurance Program (NHIP) as the prime
mover in improving financial risk protection,
generating resources to modernize and sustain
health facilities, and improve the provision of
public health services to achieve the

• DOH shall organize health sector initiatives

□ HEALTH SECTOR REFORM

into
• Philippines has joined the bandwagon of pursuing
1. Financing Service Delivery
various reforms to strengthen local health care 2. Regulation
delivery and improve health outcomes of the 3. Governance
population. 4. Plus a Cross-cutting initiative on
performance Accountability.

□ Universal Health Care in the Philippines

Fourmula One
Kalusugan
Pangkalahatan
Duterte Health
Agenda F1 plus
• Universal Health
(2005-2010)
2011-2015 2016
Means that all individuals and communities
receive the health services they need without
suffering financial hardship.

• A major milestone towards achieving UHC in

the philippines is the ratifacation of
• HSR
.
• Administrative order 2018-0014 “
• R.A 11223 is a law that will covers all
.
Filipinos
• Health )
for Health in order to address inequities in health
• All filipinos are
outcomes by ensuring that all Filipinos, especially
in the national health insurance program or
those belonging to the lowest two income
PhilHealth
quintiles, have equitable access to quality health
care. • Members are Either

• Children and Elderly are classified as

Population Based =
• Individual-Based health services to one
recipient. =

7|Page
 □ Organization of local health System.
• Healthcare system will cover a period of six
years.
• All municipal health offices will be placed
under the province-wide health system.
• City Health offices will be combined to form
city wide health system.
• Two division will be created under this
structure:
1. One
2. Health System Support

□ Health promotion and Human Resource for

health.
• DOH was tasked to create a health
promotion bureau that will undertake
initiatives for this purpose.
• DOH is also required by
UHC law to foster health consciousness in
the basic education program of the country.
• Current education programs for health
professions: (BSN, BS-MEDTECH, etc.)
will likewise be reviewed and new programs
will be developed to address health needs of
population.
• P will be
emphasized in health education and health
professions curricula.
• S will be
provided with a
agreement scheme to supply the growing
need for human resource for health.
• Priority will be given to
those who are recipient of scholars.
• Source of Funding:
1. Revenue of govt. from Sin Tax reform
law (RA 10351)
2. 50%
3. 40%
4. DOH Funding from the national budget
5. PhilHealth Subsidy from the national
govt.
6. Premium

Thank you for listening!!!!

Prepared by: Daryl Mae Amora-Casirayan, RN

8|Page