PHILIPPINE HEALTH CARE DELIVERY SYSTEM

 DEFINITIONS:
 Health Care System – an organized plan of health services (Miller-Keane, 1987)
 Health Care Delivery – rendering health care services to the people (Williams-
Tungpalan, 1981)
 Health Care Delivery System – the network of health facilities & personnel which
carries out task of rendering health care to the people
 Philippine Health Care System – is a complex set of organizations interacting to
provide an array of health services to the Filipino people (Dizon, 1977)

 MAJOR PLAYERS:
1. PRIVATE SECTOR
a. Largely market oriented
b. Health care is paid through user fees at the point of service
c. Includes profit and non-profit health providers
d. Includes providing health services in
i. Clinics
ii. Hospitals
iii. Health insurance
e. Manufacture of
i. Medicines
ii. Vaccines
iii. Medical supplies
iv. Medical equipment
v. Other health and nutrition products
vi. Research and development
vii. Human resource development
2. PUBLIC SECTOR
a. Largely financed through a tax-based budgeting system at both national
and local levels
b. Health care is generally given free at the point of service
c. Consist of the national and local government agencies

NATIONAL AGENCIES

 DEPARTMENT OF HEALTH
 Mandated as the lead agency in health
 Maintains specialty hospitals, regional hospitals and medical centers
 Maintains provincial health teams made up of DOH representatives to the
local health boards and personnel involved in CDC, specifically for malaria
and schistosomiasis
 Through Executive Order No. 119, Sec. 3
 DOH is primarily responsible for the promotion, protection, preservation of
the health of the people through the provision & delivery of health services
& through the regulation & encouragement of providers of health goods &
services
 DOH is responsible for the formulation, planning, implementation &
coordination of policies & programs in the field of health
 The mission of DOH in partnership with the people is to ensure equity,
quality & access to healthcare by:
 Making services available
 Arousing community awareness
 Mobilizing resources
 Promoting the means for better health

 PHILIPPINE GENERAL HOSPITAL

 Part of national level which provide health care services
 LOCAL LEVEL (LOCAL HEALTH SYSTEM)

 PROVINCIAL GOVERNMENT
 Provincial and District hospitals
 CITY/MUNICIPAL GOVERNMENT
 Health centers/RHU
 Barangay health stations
 LOCAL CHIEF EXECUTIVE
 Chairs the local health board
 Function is mainly to serve as advisory body to the local executive and the
sanggunian or local legislative council on health-related matters

QUESTION: You are a new B.S.N. graduate. You want to become a Public Health
Nurse. Where will you apply?
A. Department of Health
B. Provincial Health Office
C. Regional Health Office
D. Rural Health Unit

Answer: (D) Rural Health Unit

R.A. 7160 devolved basic health services to local government units (LGU’s ). The public
health nurse is an employee of the LGU.

 COMPONENTS OF HEALTH CARE DELIVERY SYSTEM

 Two-Way Health Referral System – established between each level of health

facility
 Multi-Sectoral Approach to Health
 Intersectoral Linkages
 Agriculture
 Education
 Public Works
 Local Governments
 Social Welfare
 Population Control
 Private Sectors
 Intrasectoral Linkages
 Levels of Health Care Delivery System (Pyramidal Health Structure)
Primary
o Health services offered at this level are to individuals in fair health & to
patients with disease in early symptomatic stages
o Devolved to the cities and municipalities
o Health care provided by the center physicians, PHN, RHM, BHW,
TBAs and others
o Usually the first point of contact between the community members and
other levels of health facility
o Includes barangay health station, Rural Health Units (RHU), community
hospitals & health centers, puericulture centers; private clinics operated
by large industrial firms for their employees; community hospitals &
health centers operated by Philippine Medicare Care Commission &
other health facilities operated by voluntary religious & civic groups
Secondary
 Services offered to patients with symptomatic stages of disease which
requires moderately specialized knowledge & technical resources for
adequate treatment
 Given by physicians with basic health training
  Usually given in health facilities either privately owned or government
operated such as infirmaries, municipal and district hospitals, out-patient
departments of provincial hospitals
 Serves as a referral center for the primary health facilities
 Capable of performing minor surgeries and perform some simple
laboratory examinations
 Includes smaller, non-departmentalized hospitals such as
emergency/district hospitals, provincial/city hospitals, provincial/city
health services
 Tertiary
 Services rendered at this level are for clients afflicted with diseases
which seriously threaten their health & which require highly technical &
specialized knowledge, facilities & personnel to treat effectively
 Rendered by specialists in health facilities including medical centers as
well as regional and provincial hospitals and specialized hospitals
 Referral center for the secondary care facilities
 Includes highly technological & sophisticated services offered by
medical centers & large hospitals such as regional health services,
regional medical centers & training hospitals, national health services,
medical centers, teaching & training hospitals

 National Health Plan

 The blueprint which is followed by the DOH
 It defines the country’s health problems, policy thrusts, strategies & targets

PRIMARY HEALTH CARE

 OVERVIEW:

 Definition: PHC is essential health care made universally accessible to

individuals & families in the community; by means acceptable to them; through
their full participation & at cost that the community & country can afford; in
the spirit of self-reliance & self-determination
 Conceptualized during the First International Conference on Primary Health Care
which was held in Alma Ata, USSR on September 16, 1978 sponsored by WHO
& UNICEF
 PHC is the basis of DOH Programs

 CONCEPTUAL FRAMEWORK:

 Legal Basis of PHC in the Phil.: PD 949 issued by Pres. Ferdinand Marcos on
October 19,1979
 Vision:
 Health for all Filipinos by the year 2000 & health in the hands of the people by
the year 2020
 Mission:
 To strengthen the health care system by increasing opportunities & supporting
conditions wherein the people will manage their own health care

 4 CORNERSTONES/PILLARS OF PHC **bq**

 Active community participation
 Intra & inter-sectoral linkages
 Use of appropriate technology
 Support mechanism available

 7 PRINCIPLES/STRATEGIES OF PHC
 Accessibility, availability of health services
 Delivery of health services where the people are
 Use of indigenous volunteer workers as health providers (1:10-20 ratio)
  Use of traditional (herbal) medicines together with essential drugs
 Provision of quality basic & essential health services
 Competency-based training design & curriculum based on community needs &
priorities, task analysis of Community Health Workers (CHW)
 Attitudes, knowledge & skills developed on promotive, preventive, curative &
rehabilitative health care
 Regular monitoring & periodic evaluation of CHW performances by community
& health staff
 Community participation
 Awareness building & consciousness raising on health & health related issues
 Planning, implementation, monitoring, evaluation done through small group
meetings (10-12 households)
 Selection of CHW by the community
 Community building & organizing
 Self-reliance
 Community generates support for the health program
 Use of local resources
 Training of community in leadership & management
 Incorporation of income-generating projects, cooperatives & business
 Recognition of interrelationship between health & government
 Convergence of health, food, nutrition, water, sanitation & population services
 Integration of PHC into national, regional, provincial, municipal, barangay
development plans
 Coordination of activities with economic planning, education, agriculture,
industry, housing, public works, communication & social services
 Social mobilization
 Establishment of an effective health referral system
 Multi-sectoral & interdisciplinary linkages
 Information, education, communication support using multimedia
 Collaboration between government & non-government organization
 Decentralization
 Reallocation of budgetary resources
 Re-orientation of health professionals on PHC
 Advocacy for political will & support from national leadership down to the
barangay level

 2 LEVELS OF PRIMARY HEALTH CARE WORKERS

 Village or Barangay Health Workers (VHW or BHW) – trained community health
workers or health auxiliary volunteers or a traditional birth attendant or healer
 Intermediate Level Health Workers – general medical practitioner, public health
nurse, rural sanitary inspectors, midwives (Each rural health midwife is given a
population assignment of about 5,000)

 ELEMENTS OF PHC
 Education for Health
 A potent methodology that enriches partnership with people
 Locally Endemic Disease Control
 Prevention & control of the occurrence of disease
 Expanded Program on Immunization
 Controls preventable disease by immunization
 Maternal & Child Health
 Ensure health of mother & child as most delicate members of the family
 Essential Drugs
 Information campaign on proper utilization & acquisition of drugs
 Nutrition
 Focus on the basic needs for food, its preparation & choices
 Treatment of Communicable Diseases
 Prevention & treatment of CDs
 Safe Water & Sanitation
  For water & sanitation as requisites for health promotion

QUESTION: “Public health services are given free of charge.” Is this statement true or
false? false
The statement is false; people pay indirectly for public health services.
Community health services, including public health services, are pre-paid services,
though taxation, for example.