Universal Health Care

Key Components of the

Universal Health Care Act

2
 RA 11223: Universal Health Care Act
GENERAL OBJECTIVES

To ensure equitable access to quality and affordable health care

and protection against financial risk.

Department of Health, Philippines

 What will UHC be for you?
UHC ensures that EVERYONE
will be receiving OPTIMAL HEALTH SERVICES.

Every Filipino family is matched to a primary care team, who ensures that
they get the appropriate services they need in the appropriate facility.

Department of Health, Philippines

 What will UHC be for you?
UHC ensures that NO PATIENT
WILL BE LEFT ALONE.

Creation of health networks that will navigate the patients throughout the
process of their Health Care Needs. From BHS to Higher Health Facilities back to
the BHS.

Department of Health, Philippines

 What will UHC be for you?
UHC ensures that PRIMARY CARE / COMMUNITY HEALTH
will be STRENGTHENED.

Primary Care Services and Community Health will be strengthened. Prevention is

always better than Cure.

Department of Health, Philippines

 What will UHC be for you?
LGUs will be provided with additional funding for Health Services.

Health Services in the LGU will be funded through a pooled fund. Health Workers will
be incentivized and compensated properly (Additional health workers may be
employed). Pooled fund will remain and be reflected as LGU Income.

Department of Health, Philippines

 What will UHC be for you?
LOCAL CHIEF EXECUTIVES as CHAMPIONS OF HEALTH

LGUs will be empowered to lead on Public Health in their areas. Health Governance is key to
a Healthy Community. (RA 11223 did not explicitly repeal LGC)

Department of Health, Philippines

 Universal Health Care means…

✔ healthy living, schooling ✔ primary care provider ✔ health spending is

& working environments team for every family predictable, not “lahat libre”

✔ care is provided for by providers organized as

INTEGRATED NETWORKS

Department of Health, Philippines

Integration of the Local Health Systems into
Province-wide and City-wide Health Systems

Department of Health, Philippines

Background

“The DOH, DILG, PhilHealth and LGUs shall endeavor to integrate

health systems into province-wide and city-wide health systems”
Republic Act No. 11223 or UHC Act (Section 19)

“LGUs that commit to province-wide and city-wide integration

shall ensure managerial and financial integration and provide the
needed resources and support mechanism to make the
integration possible and sustainable”
UHC Act IRR (Section 19.9)

Department of Health, Philippines

 Integrated Local Health System

APEX HOSPITAL

Department of Health, Philippines

 Sub-Provincial Health System

“In consideration of the size, population, and geography of the

province, a group of adjacent municipalities and component cities
may form sub-provincial health systems for effective health service
delivery and management of health systems.”

(UHC Act IRR Sec. 19.12.e.)

Department of Health, Philippines

 Health Care Provider Network (HCPN)

Hospital (L1/L2/L3)

School Office
Clinic Dental Clinic
Clinic Medical Outpatient
Clinic
RHU/HC RHU/HC

Diagnostics Birthing Home

Pharmacy
BHS

Department of Health, Philippines

Department of Health, Philippines
 DOH to contract P/CWHS for PhilHealth to contract HCPNs* for individual-based
population-based services. services.

Department of Health, Philippines

 Implementation Arrangement:
Managing the Province-wide and City-wide
Health System

Provincial/City Health Board Provincial/ City Health Office

stewardship of the integrated local technical services and day-to-day
health system and setting of the policy operations
and strategic direction

Department of Health, Philippines

Department of Health, Philippines
Support Units to the P/CHB

Management Support Unit

Administrative Secretariat

Assist in the management of Provide administrative and Coordinate with necessary

the SHF technical support P/CWHS stakeholders
Provincial/City Health Office
Office of the Provincial/ City
Health Officer

Administrative Unit

Health Service Health Systems

Delivery Division Support Division
Asst. PHO/CHO Officer of same level

Primary Care Hospital and other

Provider Networks Health Facilities Health Financing Information System
Operations Operations

Procurement and
Public Health Disaster Risk Performance
Supply Chain for
Program Reduction and Monitoring
Health Products and
Implementation Management Services

Epidemiologic Local Health Health Human Resource

Surveillance Health Promotion Regulation Development
Support Units to the P/CHB

Technical Management Committee

Supervisor of the Sub-Provincial Health System

Monitor and evaluate

Advocate approval of integration of public Submit reports to
funds for health health and hospital PHO
services

Initiate health care needs

assessment and Provide policy Supervise navigation,
integrated health recommendations to coordination and
planning PHO referral across members
Structure of Support Units under the P/CWHS
Local Health
PHB
Committees

MSU
Local Health
CHB
Committees

PHO MSU
Administrativ
e Unit
HSD HSS
D D CHO
Administrative
Unit

Technical Technical Technical HSDD HSSD

Management Management Management
Committee Committee Committee

Sub-Provincial Sub-Provincial Sub-Provincial

Health System Health System Health System
Department of Health, Philippines
 Implementation Arrangement:
Managerial and Technical Integration

Ordinance on Functional referral

Unified governance of the
commitment to LHS system
local health system
Integration Integrated Management
System
● Strategic Investment
Planning
● Information System
● HRH Management System
● Procurement and Supply
Functional disaster risk Chain Management System
Functional epidemiologic Proactive and effective
reduction management ● Quality Assurance System
surveillance system health promotion programs ● Financing
for health (DRRM-H)
system or campaigns

Department of Health, Philippines

 Implementation Arrangement:
Financial Integration

Creation of Special Health Board Funds exclusively used

Health Fund resolution on SHF use for health and health-
related needs

Department of Health, Philippines

 Implementation Arrangement
Phases of Integration
PHASE 1: PHASE 2: PHASE 3:
PREPARATORY ORGANIZATION IMPLEMENTATION
PHASE OF P/CWHS MONITORING
1. Stakeholder buy-in 1. SHF managed by the P/CHB 1. LGU health Scorecard
2. Baseline studies and 2. Strengthen the Primary Care 2. Integration Maturity Level
situational analysis Provider Network and
3. Formalize LGU commitment hospitals
4. Additional member/s to the 3. Strengthening management
P/C health board and support systems
establishment of its 4. P/CWHS contracted by DOH
management support unit and PhilHealth
5. Strengthen the P/CHO
6. Create the SHF account
7. Develop Local Investment
Plan for Health

Department of Health, Philippines

Local Health Systems Maturity Levels
General framework in the
Used in complementation
monitoring and
with the LGU Health
evaluation of the
Scorecard and other
progress of LHS
existing M&E Systems
integration

Pathway to progressively Basis in formulating and

realize the reform on updating PPAs in relation
integration to LHS integration

Local Health Systems Maturity Levels

Reference to determine kind and level of

assistance, incentives, and/or recognition and
awards for LGUs to support LHS integration
Components of the LHS ML Local Health Systems Maturity Levels

Fundamental components of the health

Building Blocks systems based on WHO

Characteristics of P/CWHS that

Characteristics achieved managerial and financial
integration based on the UHC Act IRR

Minimum outputs expected to be

Key Result
delivered by the P/CWHS that can
Areas facilitate the achievement of integration
Components of the LHS ML Local Health Systems Maturity Levels

 Preparatory Level (Level 1) – covers

KRAs relating to preparatory works and
other supporting mechanisms needed for
the integration
 Organizational Level (Level 2) – covers
Levels of KRAs that are important for organization
Progress and management of the integrated LHS.
Other UHC Act reforms that have effects
on integration.
 Functional Level (Level 3) – cover KRAs
to monitor functionality of the integrated
management support systems
Components of the LHS ML: Summary Local Health Systems Maturity Levels

Key Result Areas

Building Block Characteristics
Level 1 Level 2 Level 3 Total
Unified Governance of the
2 4 3 9
Leadership & Local Health System
Governance Strategic and Investment
1 2 1 4
Planning
Financing Financial Management 0 6 2 8
Health HRH Management and
1 4 2 7
Workforce Development
Information Management
1 4 2 7
System
Information
Epidemiologic Surveillance
1 2 4 7
System
Components of the LHS ML: Summary Local Health Systems Maturity Levels

Key Result Areas

Building Block Characteristics
Level 1 Level 2 Level 3 Total
Medical
Products, Procurement and Supply
2 4 2 8
Vaccines and Chain Management
Technology
Referral System 3 7 2 12
Service DRRM-H System 2 3 2 7
Delivery
Health Promotion
4 4 2 10
Programs or Campaigns
TOTAL 17 39 22 79
Discussion
1. What will be the configuration/ model of your Province/city-wide
HCPN?
2. What will be the management structure of your Province/city-wide
HCPN?
3. What are the roles of each member office/organization of the HCPN
management committee/TWG?
4. What is the organizational structure of your Provincial/ City Health
Office?
5. What is the proposed structure of your Provincial/ City Health Office?
6. What are the mechanisms for transition?
 Points for Analysis and Discussion
 Based on the discussion, identify possible entry points of the LGUs in
establishing their Health Care Provider Network. Possible entry points
include interlocal health zones or through the district systems. Hence,
different models of HCPNs may also be considered. These could be in the
following forms: (1) single LGU HCPN like that in a city; (2) multiple HCPNs
for large LGU; These are done through clustering or dividing the barangays
into districts. These would also depend on the number of apex hospitals
available; and (3) sub-provincial health systems from a functioning Interlocal
Health Zone (ILHZ) model linked to an apex hospital.
 Key Messages

1. The LGUs act as the lead implementers of the LHS integration. The DOH
and other health partners shall serve as the provider of the needed
technical and financial support.  

2. The configuration of the governance and management structure and

LGUs’ cooperative agreements are deemed essential in the success of the
integration of the local health systems into P/CWHS.
 Key Messages

3. P/CWHS agreements and financing mechanisms, i.e., management of the

Special Health Fund, would depend on the configuration of the P/CWHS
structure.

4. The LHS ML shall be the basis of DOH, attached agencies, development

partners and stakeholders in formulating and updating their respective
programs, projects and activities in relation to the integration of the local
health systems. It shall likewise serve as one of the instruments in
determining the kind and level of assistance provided to the LGUs.
 Recommended Action Points

1. Secure the legal and political support of the provinces, HUCs, ICCs, component
cities, and municipalities to integrate their local health systems. This involves
engaging the LGUs through advocacies, dialogues and orientations on UHC Act,
F1 Plus for Health, and other national policy goals and directions.

2. Formalize the LGU commitment to collaborate with other LGUs.

 Recommended Action Points

3. Organize the management structure. Organize/ Strengthen policy and technical management
structures, such as:

Additional member/s to the P/CHB;

• A consultation process must be undertaken in determining the appropriate number of
members, particularly the representative/s of municipalities and component cities
included in the PWHS, taking into consideration the quorum and manageability of board
meetings, and size and geography of the province. 

Creation of a Management Support Unit:

• The Board may decide to appoint, designate, or hire additional staff, as deemed necessary.
 
 Recommended Action Points

3. Organize the management structure. Organize/ Strengthen policy and technical management
structures, such as:
 
Establishment of at least two technical divisions in the P/CHO; and
• Issuance of an enabling ordinance to create the Assistant Provincial/ City Health Office
and another official of equivalent rank, as well as other necessary staff needed per
division, as plantilla items if not yet present. Until such time that the plantilla positions
have been created, existing personnel may be designated/ detailed.
 
Creation of the technical management committee, as deemed necessary.
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