The Health Care Delivery System

(3rd part)

Rosita Dulay Vianzon

Instructor COHN 1, SY 2022-2023 1ST SEM
 Primary Health Care (PHC)

 an essential health care made universally

accessible to individuals and families in
the community by means acceptable to
them through their full participation and
at a cost that the community and
country can afford at every stage of
development. (WHO)

 Declaration: during the First International

Conference on PHC held in Alma Ata,
USSR on September 6-12, 1978, by WHO.
PRIMARY HEALTH CARE

According to the Declaration of Alma Ata, Primary

Health Care, is "essential health care based on
practical, scientifically sound and socially
acceptable methods and technology made
universally accessible to individuals and families in
the community through their full participation and at
a cost that the community and country can afford to
maintain at every stage of their development in the
spirit of self-reliance and self-determination."
History of PHC

 May 1977 – The 30th World Health Assembly adopted

resolution WHA 30:43. This resolution decided that the
main social target of governments and of WHO should be
the attainment by all the people of the world by the year
2000 a level of health that will permit them to lead socially
and economically productive life
 September 12, 1978 - International Conference on
Primary Health Care was held in this year at Alma Ata,
USSR.
 The conference came up with what is popularly known
Alma Ata Declaration, which represents a global ideal, a
new vision on how to achieve world health. The
declaration stated that primary health care is the key to
attaining the health-for-all goal.
 1979 – The WHA launched the Global Strategy for health-
for-all
 October 19, 1979 – the President of the Philippines, issued a
Letter of Instruction 949 which mandated the then Ministry
of Health to adopt the Primary Health Care as an approach
towards design, development, and implementation programs,
which focus health development at the community level.
Primary Health Care (PHC) cont.

 Goal: “Health for All by the year 2000”.

 Adopted in the Philippines through Letter of
Instruction 949 signed by President Marcos on
October 19, 1979
 Theme: “Health in the Hands of the People by
2020.”
 Concept: characterized by partnership and
empowerment of the people that shall permeate as the core
strategy in the effective provision of essential health
services; that are community based, accessible, acceptable
and sustainable at a cost which the community and the
government can afford
 Primary Health Care (PHC) cont.

Focus of Responsibility: health on the individual,

his family and the community.

o includes the full participation and active involvement

of the community towards the development of
self-reliant people, capable of achieving an acceptable
level of health and well-being.
o recognizes the interrelationship between health
and the overall political, socio-cultural and economic
development of society.
 Primary Health Care (PHC) cont.

 February 23-24, 2006, PHC Summit:

 showcased the various community managed health
activities that has successfully placed health in the
hands of the people in this country.

Elements/Components of PHC:
 1. Environmental sanitation
 2. Control of Communicable Diseases
 3. Immunization
 4. Health education
Primary Health Care (PHC) cont.

Elements/Components of PHC: (cont.)

 5. Maternal and Child Health and Family Planning

 6. Adequate Food and Proper Nutrition
 7. Provision of Medical Care and Emergency
Treatment
 8. Treatment of Locally Endemic Diseases
9. Provision of Essential Drugs
 PHC Principles
1. Accessibility, availability, affordability, and
acceptability of health services
2. Provision of quality, basic and essential health
services. the interrelationship of health and
development
3. Community participation
4. Self-reliance
5. Recognition of the interrelationship of health
and development
6. Social mobilization
7. Decentralization
 Primary Health Care (PHC) cont.

Strategies:
1. Reorientation and reorganization of the national
health care system with the establishment of functional
support mechanism in support of the mandate of
devolution under the Local Government Code of 1991.
2. Effective preparation and enabling process for health
action at all levels.
3. Mobilization of the people to know their communities
and identifying their basic health needs with the end in
view of providing appropriate solutions leading to self-
reliance and self-determination.
Primary Health Care (PHC)
Strategies: (cont.)
4. Development and utilization of appropriate technology
focusing on local indigenous resources available in and
acceptable to the community.
5. Organization of communities arising from their
expressed needs which they have decided to address and
that this is continually evolving in pursuit of their own
development.
6. Increase opportunities for community participation in
local level planning, management, monitoring and
evaluation within the context of regional and national
objectives.
Primary Health Care (PHC)
Strategies: (cont.)
7. Development of intra-sectoral linkages with other
government and private agencies so that programs of the
health sector is closely linked with those of other
socio-economic sectors at the national, intermediate and
community levels.
8. Emphasizing partnership so that the health
workers and the community leaders/members
view each other as partners rather than merely
providers and receiver of health care respectively
Primary Health Care (PHC)

Four cornerstones/pillars in PHC

1. Active community participation
2. Intra and inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

Types of PHC workers that vary in different

communities depending upon:
 Available health manpower resources
 Local health needs and problems
 Political and financial feasibility
Primary Health Care (PHC)

2 Levels of PHC workers:

1. Village or Barangay Health Workers
2. Intermediate level health workers

Levels of Health Care and Referral System:

1. Primary Level of Care
a. The first contact between the community
members and the other levels of health
facility.
Primary Health Care (PHC)

2 Levels of PHC workers: (cont.)

2. Secondary Level of Care

a. Capable of performing minor surgeries
and perform some simple laboratory
examinations.
3. Tertiary Level of Care
a. Complicated cases and intensive care
requires tertiary care and all these can be
provided
Levels of Prevention
  PRIMARY Secondary TERTIARY
Prevention Prevention Prevention
Definition An intervention An intervention implemented In intervention
implemented before there after a disease has begun, but implemented after a
is evidence of a disease or before it is symptomatic disease injury is
injury established
Intent Reduce or eliminate risks Early identification (through Prevent sequelae (stop
factors Risk reduction) screening) and treatment bad things from getting
worse)

Example Encourage exercise and Check body mass index Help obese individuals
healthy eating to prevent (BMI) at every well checkup lose weight to prevent
individuals from to identify individuals who progression to more
becoming overweight are overweight or obese severe consequences.
 Towards universal health coverage
and the sustainable development
goals
 World Health Organization and the
United Nations Children’s Fund
(UNICEF), 2018
 (https://www.who.int/docs/default-source/
primary-health/vision.pdf)
 A Vision for Primary Health Care in the 21st century

 October 2018: commemoration of the 40th anniversary

of the 1978 Declaration in Astana, Kazakhstan (w/ world
health leaders, international organizations, civic
organizations, civil society organizations and other stakeholders.)
 Astana Declaration on Primary Health Care: a new
document has been developed after global public
consultation involving experts and civil society, and
detailed negotiations between the WHO Member States.
A vision for primary health care in the 21st century (cont.)

 Astana Declaration on Primary Health Care:

will be officially launched at the Astana Global Conference
on Primary Health Care
a call will be made for governments to give high priority to
PHC, including in non-health sectors, in partnership with
their own public and private sector organizations,
development partners and other stakeholders.
A vision for primary health care in the 21st century (cont.)
 The Declaration of Alma-Ata in 1978 was a landmark in the history of
global health.
 Forty years later, the Global Conference on Primary Health Care and its
associated Declaration renew a commitment to primary health care (PHC)
in pursuit of health and well-being for all, leaving no one behind.
 The focus on PHC is critical at this moment for three reasons:
1. The features of PHC allow the health system to adapt
and respond to a complex and rapidly changing world.
A vision for primary health care in the 21st century (cont.)

 The focus on PHC (three reasons)

2. With its emphasis on promotion and prevention,
addressing determinants, and a people-centered
approach, PHC has proven to be a highly effective and
efficient way to address the main causes of, and risk
factors for, poor health, as well as for handling the
emerging challenges that may threaten health in the
future.
3. Universal health coverage (UHC) and the health-related
sustainable development goals (SDGs) can only be
sustainably achieved with a stronger emphasis on PHC.
A vision for primary health care in the 21st
century (cont.)
 The concept of PHC (a modern concept)
 is aligned with and contributes to the SDGs and UHC.
 a whole-of-society approach to health
 Aim: equitably to maximize the level and distribution of health and
well-being
 Focus: on people’s needs and preferences (both as individuals and
communities) as early as possible along the continuum from health
promotion and disease prevention to treatment, rehabilitation and
palliative care, and as close as feasible to people’s everyday
environment.
A vision for primary health care in the 21st
century (cont.)
 Three inter-related and synergistic components
 1. Meeting people’s health needs through comprehensive:
 promotive, protective, preventive, curative, rehabilitative, and
palliative care throughout the life course,
 strategically prioritizing key health care services aimed at
individuals and families through primary care and the population
through public health functions as the central elements of integrated
health services
 A vision for primary health care in the 21st
century (cont.)
 Three inter-related and synergistic components
 2. Systematically addressing the broader determinants of health
(including social, economic and environmental factors, as well as
individual characteristics and behaviors) through evidence-informed
policies and actions across all sectors; and
 3. Empowering individuals, families, and communities to optimize
their health, as advocates for policies that promote and protect health
and well-being, as codevelopers of health and social services, and as
self-carers and caregivers.
COMPONENTS OF PHC
(https://www.who.int/docs/default-source/primary-health/vision.pdf)

 PHC is a whole-of-society approach to health that

aims to ensure the highest possible level of health
and wellbeing and their equitable distribution by
focusing on people´s needs and preferences (as
individuals, families, and communities) as early as
possible along the continuum from health promotion
and disease prevention to treatment, rehabilitation
and palliative care, and as close as feasible to
people’s everyday environment.
 A vision for primary health care in the 21st
century (cont.)
 Vision: places People, as individuals and communities, as the
central focus of all efforts towards PHC.
 People’s fundamental right to the highest attainable standard of
health and well-being, and the world’s renewed commitment to
social justice, are expressed through adequate social protection
and concerted efforts to address the needs of those who are most
disadvantaged.
 A vision for primary health care in the 21st
century (cont.)
 People are protected from adverse health outcomes through
population-based measures, planned and delivered with
consideration for the needs of those served.
 Includes: prevention and control of locally endemic diseases and
disease outbreaks, prevention of noncommunicable diseases, and
information and education concerning prevailing health problems,
including major risks, and how to prevent and control them.
 A vision for primary health care in the 21st
century (cont.)
 the context of individual care, a trusted multidisciplinary
primary care team supports patients in prioritizing and
identifying care goals.
 Teams approach individual patient care
 considers the patient’s cultural preferences and stage of
life, across a wide range of problems (mental and
physical, chronic and acute, communicable and
noncommunicable).
 A vision for primary health care in the 21st
century (cont.)

 Teams approach individual patient care

 responsible for assessing the health needs of the
patient, providing safe, evidence-based, cost-efficient
management through appropriate use of health
technologies and information technology, and
coordinating additional or specialized services for
patients who need them through wider PHC networks.
Broad determinants of
health:
• Social addressed Involve:
• Economic through action  multiple sectors of
• Environmental
government,
• associated commercial  civil society
factors  private sector, sustain societies
and environments
that foster health
and well-being.

Teams approach individual patient care

 A vision for primary health care in the 21st
century (cont.)
 Teams approach individual patient care
 Close collaboration among sectors, such as social protection,
housing, education, agriculture, finance, and industry,
enables people to live in health-promoting neighborhoods
that combine clean air, walkability and accessibility, green
spaces, road safety and effective public transit options.
 Efforts to advance health and well-being are anchored in and
informed by the community.
 A vision for primary health care in the 21st
century (cont.)

 Teams approach individual patient care

 People have access to the knowledge, skills and resources
needed to care for themselves and their loved ones,
leveraging the full potential of health technologies as well as
information and communications technologies (ICT).
 Universal Health Care (UHC)

 referred to as Kalusugan Pangkalahatan (KP),

 “provision to every Filipino of the highest possible
quality of health care that is accessible, efficient,
equitably distributed, adequately funded, fairly
financed, and appropriately used by an informed and
empowered public”.

 The Aquino administration defined it as the availability

and accessibility of health services and necessities for
all Filipinos.
 Universal Health Care (UHC) [cont.]

 a government mandate aiming to ensure that

every Filipino shall receive affordable and quality health
benefits.
 involves providing adequate resources – health
human resources, health facilities, and health financing.

Goals and Objectives

1. Better health outcome
2. Sustained health financing
3. Response health system by ensuring that all Filipinos
especially the disadvantage group have equitable access
to affordable health care.
 Universal Health Care (UHC) [cont.]

Three Strategic Thrusts:

1. Financial risk protection through expansion 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 Development
Goals (MDGs).
 
 Universal Health Care (UHC) [cont.]

To Achieve the three Strategic Thrusts, 6 Strategic

Instruments shall be optimized

 1. Health financing
 2. Service delivery
 3. Policy standards, and regulations
 4. Governance for health
 5. Human resources for health
 6. Health information