THE HEALTH

CARE DELIVERY
SYSTEM
TOPICS
The World Health Organization (WHO)
The Millennium Development Goals
The Philippine Health Care Delivery
System
 OBJECTIVES
 Discuss how the WHO affects health issues in the Philippines
 List the Millennium Development Goals(MDGs) and the
targets of the health related MDGs
 Describe the Philippine Health Care Delivery System in terms
of the Different levels of service
 Differentiate the referral system from the interlocal health
zone
INTRODUCTION
A nation’s HCDS has a tremendous impact not only
on the health of its people but also on their total
development
HCDS often involves issues of cost and challenges
Nations struggle to overcome the multiple forces in
efforts to advance the health w/in the context of their
financial & political situations
INTRODUCTION
 Anderson & McFarlane
 Emphasized the role of following factors in shaping 21 st
century health that further influence HCDS:
 Health care reforms
 Demographics
 Globalization
 Poverty and growing disparities and social disintegration
INTRODUCTION
 Philippines
 Health services are provided by the government and the private
sector(profit or non-profit)
 National Level
 Direction is set by DOH
 RA 7160( local government code)
 LGU should have an operating mechanism to meet the priority
needs and service requirements of their communities
 Basic health services are regarded as priority services, w/c LGU’s
are responsible
INTRODUCTION
Health System
Consists of all organizations, people and
actions whose primary intent is to
promote, restore, maintain health
HEALTH SYSTEM: BUILDING
BLOCKS
 Service delivery
 Health workforce
 Information
 Medical products,vaccines and technologies
 Financing
 Leadership and governance or stewardship
INTRODUCTION
 The nurse is an essential member of the health workforce in
the country
 To work efficiently within the HCDS
 Understanding of the dynamic relationships among its
components is needed
 Example: a nurse who able to understands the referral
system will be able to refer patients to the appropriate
facility or health personnel
WORLD HEALTH
ORGANIZATION
WORLD HEALTH
ORGANIZATION
 1945
 Diplomats formed the UN
 Discussion of the creation of a global health organization
 The WHO is the outcome of these discussions
 April 7, 1948
 WHO constitution came into force
 World Health Day every April 7
WORLD HEALTH
ORGANIZATION
Geneva, Switzerland- WHO headquarters
Has 147 country offices and 6 world regional
offices for Africa, Americas, Eastern
Mediterranean, Europe, Southeast Asia and
the Western Pacific
Philippines is a member of Western Pacific
Region, w/c holds office in Manila
 WORLD HEALTH
ORGANIZATION
Objective:
Attainment by all peoples of the
highest possible level of health
WHO: CORE FUNCTIONS
Providing leadership on matters critical to health and
engaging in partnerships where joint action is needed
 WHO has 193 countries a 2 associate members
WHO and its members work with UN agencies,
NGOs and the private sector
Focus is directed toward providing technical
collaboration w/member states in accordance w/
each country’s needs and capacities
 WHO: CORE FUNCTIONS
 Shaping the research agenda and stimulating the generation,
translation and disseminating valuable knowledge. The WHO
strategy on research has five goals:
 Capacity in reference to capacity-building to strengthen nat’l
health research systems
 Priorities to focus research on priority health needs particularly in
low-and middle-income countries
 Standards to promote good research practice and enable the
greater sharing of research evidence, tools and materials
 WHO: CORE FUNCTIONS
 Translation to ensure that quality evidence is turned into
products and policy
 Organization to strengthen the research culture w/in WHO and
improve the management and coordination of WHO research
activities
 WHO: CORE FUNCTIONS
 Setting norms and standards and promoting and monitoring
their implementation.
 Articulating ethical and evidence-based policy options
 Providing technical support, catalyzing change and building
sustainable institutional capacity
 THE MILLENNIUM
DEVELOPMENT GOALS
 September 6 to 8, 2000
 World leaders in the UN General Assembly participated in the
Millennium Summit
 United Nations Millennium Declaration- result of the summit
 Recognized the 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 MDGs—by the year
2015
 THE MILLENNIUM
DEVELOPMENT GOALS
 Eradicate extreme poverty and hunger
 Achieve universal primary education
 Promote gender equality and empower women
 Reduce child mortality. Target:
 Reduce by 2/3 between 1990-2015, the under-five mortality
rate
 Improve maternal health. Targets:
 Reduce by three quarters the maternal mortality ratio
 Achieve universal access to reproductive health
 THE MILLENNIUM
DEVELOPMENT GOALS
 Combat HIV/AIDS, malaria and other diseases, Targets:
 Have halted by 2015 and begun the spread of HIV/AIDS
 Achieve, by 2010, universal access to tx for HIV/AIDS for all
those who needs it
 Have halted by 2015 and begun to reverse the incidence of malaria
and other major diseases
 Ensure environmental sustainability
 Develop a global partnership for development
 THE MILLENNIUM
DEVELOPMENT GOALS
5 out 8-- not considered as strictly health issues
However, these 5 MDGs are health related issues
They are goals toward upgrading the socioeconomic
conditions
Socioeconomic conditions are in themselves, health
determinants
SUSTAINABLE
DEVELOPMENT
GOAL
 Adopted in September 2015 at an historic UN Summit
 Build on the success of the Millennium Development
Goals, aiming to go further by ending all forms of poverty,
fighting inequalities and tackling climate change
 Apply to low-, middle- and high-income countries alike
 Governments are expected to take ownership and establish
national frameworks for achieving the goals
 The clock already started on 1 January, 2016
WHAT IS SUSTAINABLE
DEVELOPMENT?
 Meets the needs of the present without compromising the
ability of future generations to meet their own needs
 Calls for concerted efforts toward building an inclusive,
sustainable and resilient future for people and planet
 Relies on three interconnected elements that are crucial to the
well-being of individuals and societies: economic growth,
social inclusion and environmental protection
 Requires eradicating poverty in all its forms and dimensions
GLOBAL STRATEGIES

WHO-UNICEF Action Plan for Healthy Newborn

Infants 2014-2020 for the Western Pacific Region
GLOBAL STRATEGIES
GLOBAL TARGETS 2025: TO IMPROVE MATERNAL,
INFANT AND YOUNG CHILD NUTRITION
GLOBAL MOVEMENT FOR
NUTRITION ADVOCACY
GLOBAL MOVEMENT FOR
NUTRITION ADVOCACY
THE PHILIPPINE
HEALTH CARE
DELIVERY
SYSTEM
 PHCDS
 The DOH serves as the governing body of health services in the
country
 DOH
 Provides guidance and technical assistance to LGUs tru CHD(Center
for Health Dev’t) in each of the 17 regions
 Provincial governments are responsible for administration of prov’l
and district hosps.
 Municipal and city governments are in charge of primary care thru
RHUs or health centers
 BHS- serves as satellite outposts; provide health services in the
periphery of the municipality or city
 PHCDS
 Local Gov’t Code- mandated the devolution or decentralization
of basic health services
 This means that LGU have the autonomy and responsibility to plan
and implement basic health services(primary care) in behalf of their
constituents
 This is a mandate for LGUs but it is still depends on the
capability and political will of the municipality/city gov’t.
 Thus it is possible for a city/municipality to administer secondary
or tertiary hosp
 Ex: Ospital ng Maynila Medical Center(funded by the city gov’t of
Manila)
 PHCDS
 Private sectors (profit & nonprofit)

 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

 An estimated 60% of health expenditure goes to the private
sector

 This sector also employs 70% of the health professionals in the

Philippines( Romualdez,2011)
 PHCDS
 Financing of health services is provided by 3 major groups:
 Government (national or local)
 Private sources
 Social health insurance
 The leading payment scheme is out-of-pocket, accounting
for 40-50% of the total health expenditure
 Nat’l Health Insurance Act of 1995( RA 7875)
 Created the Phil Health Insurance Corporation(PhilHealth)
DOH
 DOH
Is the nat’l agency mandated to lead the
health sector towards assuring quality health
care for all Filipinos
DOH: VISION
To be a global leader for attaining
better health outcomes, competitive and
responsive health care system and
equitable health financing
DOH: MISSION
To guarantee equitable, sustainable,
and quality health for all Filipinos,
especially the poor and to lead the
quest for excellence in health
DOH: GOAL
 Health Sector Reform Agenda(HRSA)
 Health Sector reform is the overriding goal of the DOH
 Support Mechanisms will be through sound organizational
development, strong policies,systems and
procedures,capable human resources and adequate financial
resources
DOH: RATIONALE FOR HSR
 Following conditions are still seen among the population
 Slowing down in the reduction in the IMR & the MMR
 Persistence of large variations in health status across pop’n groups
and geographic areas
 High burden from infectious diseases
 Unattended emerging health risks from environment and work-
related factors
 Burden of disease is heaviest on the poor
 DOH: RATIONALE FOR HSR
 Reasons why the conditions are still seen among the pop’n:
Inappropriate health delivery system as shown by an
inefficient and poorly targeted hospital system,
 Ineffective mechanism for providing public health
programs on top of health human resources
maldistribution
DOH: RATIONALE FOR HSR
 Reasons why the conditions are still seen among the pop’n:
 Inadequate regulatory mechanisms for health services, high
cost of drugs and presence of low quality of drugs in the
market
 Poor health care financing and inefficient sourcing generation
of funds for healthcare
 DOH: RATIONALE FOR HSR
 Implications:
 Poor coverage of public health and primary care services
 Inequitable access(physical and financial) to personal health
care services
 Low quality and high cost of both public and personal health
care
DOH: RATIONALE FOR HSR
Areas needed to be reformed
Health financing
Health regulation
Local health systems
Public health programs and hospital systems
 FRAMEWORK FOR IMPLEMENTATION
OF HSRA: FOURMULA ONE FOR
HEALTH
 This is adopted as the implementation framework for health
sector reforms
 It intends to implement critical interventions as a single package
backed by effective management infrastructure and financing
arrangements following a sector wide approach
:FOURMULA ONE FOR HEALTH: GOALS
Better health outcomes
More responsive health systems
Equitable health care financing
:FOURMULA ONE FOR HEALTH:
Health financing
Health regulation
Health service delivery
Good governance
:FOURMULA ONE FOR HEALTH:
Health financing
 The goal of this health reform area is to foster greater,
better and sustained investments in health
 Phil Health Insurance Corporation,thru the Nat’l Health
Insurance Program and the DOH thru sectorwide policy
support will lead this component jointly
:FOURMULA ONE FOR HEALTH:
Health regulation
 The goal is to ensure the quality and affordability of health
goods and services
 :FOURMULA ONE FOR HEALTH:
Health service delivery
 The goal is to improve and ensure the accessibility and
availability of basic and essential health care in both public and
private facilities and services
:FOURMULA ONE FOR HEALTH:
 Good governance
 The goal is to enhance health system performance at the national
and local levels
:FOURMULA ONE FOR HEALTH:
 Key feature of F1 for health implementation
 Engagement of the Nat’l Health Insurance Program as the main lever
to effect desired changes and outcomes in each of the 4 components
DOH: MAJOR ROLES
Leader in health
Enabler and capacity builder
Administrator of specific services
DOH: MAJOR ROLES
 Leadership role of the DOH
 Is specifically elucidated in EO 102,series of 1999
 Planning and formulating policies of health programs and services
 Monitoring and evaluating the implementation of health programs,
projects, research, training and services
 Advocating for health promotion and healthy lifestyles
 Serving as a technical authority in disease control and prevention
 Providing administrative and technical leadership
DOH: MAJOR ROLES
 As enabler and capacity builder
 Providing logistical support to LGUs, private sector, & other
agencies implementing health programs and services
 Serving as the lead agency in health and medical research
 Protecting standards of excellence in the training and
education of health care providers at all levels of the health
care system
DOH: MAJOR ROLES
 As administrator of specific services
 Serve as administrator of selected health facilities at
subnational levels that act as referral centers
 Provide specific program components for conditions that
affect large segments of the population
 Develop strategies for responding to emerging health needs
 Provide leadership in health emergency preparedness and
response services
DOH: MAJOR ROLES
 Develop strategies for responding to emerging health needs
 Provide leadership in:
 health emergency preparedness and
 response services,
 including referral and networking systems for:
 trauma,
 injuries, and
 catastrophic events
LEVELS OF
HEALTH CARE
DELIVERY
HISTORICAL BACKGROUND
Philippine Health care System(over 40 yrs after post war
independence)
Administered by a central agency based in Manila
This control agency provided the singular sources of
resources,policy direction, technical and administrative
supervision to all health facilities nationwide
HISTORICAL BACKGROUND
1991: major shift happened
Local gov’t code(R.A. 7160)
All structures, personnel and budgetary
allocations from the provincial health level down
to the brgys were devolved to the LGU to
facilitate health service delivery
HISTORICAL BACKGROUND
Devolution made local government executives
responsible to operate local health care services
New centers of authority for local health services
emerged; consist of:
Provincial
City
Municipality
Autonomous regional gov’t and a metropolitan authority
LEVELS OF HEALTH CARE
DELIVERY
 Advances in health sciences and services have brought about
the development of different types of health facilities
 In response, the DOH issued AO 2012-0012
 Rules and regulations governing the new classification of
hospitals and other health facilities in the Philippines
LEVELS OF HEALTH CARE
DELIVERY
 Although the levels of health care delivery have remained the
same: primary,secondary and tertiary---the classification scheme
has changed
 Hospitals:
 General hosp
 Provides services for all kinds of illnesses
 Services offered defined it as: level 1.2.3
 Specialty hosp
 Offers services for a specific disease or condition or type of
patient(children.elderly,women)
 LEVELS OF HEALTH CARE
DELIVERY
DOH AO 2012-0012: classifies other health facilities as follows;

 Category A. Primary care facility
 A first contact health care facility that offers basic services
including emergency services and provision of normal deliveries
 Without in-patient beds(health centers, out-pt clinics, dental
clinics)
 With in-patient beds
 Short-stay facility where the pt spends on the ave. of 1or 2
days
 Infirmaries, lying-in
 LEVELS OF HEALTH CARE
DELIVERY
Category B. Custodial Care Facility


 Provides long term care, including basic services like food and
shelter, to patients w/ chronic conditions requiring ongoing health
care

 Ex: psychiatric facilities,rehab centers, sanitaria/leprosaria &

nursing homes
 LEVELS OF HEALTH CARE
DELIVERY
Category C. Diagnostic/therapeutic Facility

 A facility for the examination of the human body, specimens from the
human body, water analysis
 The test covers the preanalytical,analytical and postanalytical phases of
examination
 LEVELS OF HEALTH CARE
DELIVERY
Category C. Diagnostic/therapeutic Facility

 Further classified into:
 Laboratory facility, such as, but not limited to the following:
 Clinical lab
 HIV testing lab
 Drug testing lab
 NBS lab
 Lab for dringking H2O analysis
 LEVELS OF HEALTH CARE
DELIVERY
Category C. Diagnostic/therapeutic Facility

 Further classified into:

 Radiologic facility providing services such as x-ray, CT

scan,mammography,MRI, & ultrasonography
 LEVELS OF HEALTH CARE
DELIVERY
Category C. Diagnostic/therapeutic Facility

 Further classified into:
 Nuclear medicine facility
 A facility regulated by the Phil Nuclear Research Institute utilizing
applications of radioactive materials in dx, tx, or medical research
w/ the exception of the use of sealed radiation sources in
radiotheraphy as in internal radiation theraphy
 LEVELS OF HEALTH CARE
DELIVERY
Category D. Specialized outpatient Facility

 A facility that performs highly specialized procedures on an outpatient
basis
 Ex:
 dialysis clinic
 Ambulatory surgical clinic
 Rehab center
 CA chemotherapeutic center
 CA radiation facility
THE RURAL
HEALTH UNIT
RHU
 Commonly known as “health center”
 A primary level facility in the municipality
 Focus:
 Preventive and promotive health services
 Supervision of BHS
 Recommended ratio(RHU to catchment pop’n)
 1 RHU: 20,000 pop’n
BHS-BARANGAY HEALTH STATION

 First-contact health are facility

 Offers basic services 2 the barangay level
 It is a satellite station of the RHU
 It is manned by volunteer BHWs under the supervision of
RHM
THE RHU
PERSONNEL
MHO-MUNICIPAL HEALTH OFFICER
 Also known as Rural Health Physician
 Heads the health services at the municipal level & carries
out the ff roles & fxns:
 Administrator of the RHU
 Prepares the municipal health plan & budget
 Monitors the implementation of basic health services
 Management of the RHU staff
MHO-MUNICIPAL HEALTH OFFICER
 Community Physician
 Conducts epidemiological studies
 Formulates HE campaigns on dse. prevention
 Prepares & implements control measures or rehabilitation plan
 Medico-legal officer of the municipality
 Ratio: 1 is to 20k pop’n( RA 7305; magna carta of PHW)
PHN-PUBLIC HEALTH NURSE
 Supervises & guides all RHMs in the municipality

 Prepares the FHSIS quarterly and annual reports of the

municipality for submission to the PHO

 Utilizes the nsg process in responding to health care needs,

including needs for HE & promotions of ind’ls,families and
catchment comty
PHN-PUBLIC HEALTH NURSE
 Collaborates w/ the other members of the health team,
government agencies, private businesses, NGOs & Pos to
address the comty problems

 Ratio: 1PHN : 20k pop’n (RA 7305)

RHM- RURAL HEALTH MIDWIFE
 Manges the BHS and supervises & trains the BHW
 Provides midwifery services and executes health care
programs and activities for women w/ reproductive age,
including FP counseling & services
 Conducts patient assessment & dxfor referral or further mgt
RHM- RURAL HEALTH MIDWIFE
 Performs health information, education, & communication
activities
 Organizes the community
 Facilitates barangay health planning and other community
health services
 Recommended ratio: 1: 5,000 pop’n
RSI- RURAL SANITARY INSPECTOR
 The functions of RSI directed towards ensuring a healthy
environment in the municipality
 Entails advocacy, monitoring and regulatory activities:
 Inspection of water supply
 Inspection of unhygienic household conditions
BHW- BARANGAY HEALTH WORKER
 Considered as the interface between the community and the
RHU
 Trained in preventive health care on
 MCH
 FP
 RH
 Nutrition
 Sanitation
BHW- BARANGAY HEALTH WORKER
 Assist in providing basic services at the BHS and the RHU
 Accredited w/ the local health board accdg to DOH
guidelines
 Entitled for hazard and subsistence allowances( RA 7883,
BHW benefit and incentives act)
 Recommended ratio: 1: 20 HH
THE HEALTH
REFERRAL
SYSTEM
HEALTH REFERRAL SYSTEM
 Implemented since 1992
 Devolution- brought decision making and accountability on
basic government services closer to the people---- allow
leaders to have a greater hand in future comtys.
 brought HCDS fragmentation-----resulted to 3 level
system( where local and nat’l gov’t are responsible for
independent services
REFERRAL
A set of activities undertaken by health
care provider/facility in response to its
inability to provide intervention to
satisfy patient’s need
REFERRAL SYSTEM
 Ensures continuity and complementation of health and
medical services
 It is comprehensive
 Encompassing promotive
 Preventive
 Curative
 Rehabilitative care
REFERRAL SYSTEM
 Engages all health facilities from the lowest to the highest
level
 Movement of patient from the health center of first contact
to the hospital at 1st referral level
TWO-WAY REFERRAL SYSTEM
Ex: when the hospital intervention has
bee completed, the patient is referred
back to the health center
REFERRAL SYSTEM
 Internal referrals
 Occur w/in the health care facility( from one personnel to
another)
 Ex: RHM to PHN or PHN to MHO
 External referral
 Movement if patient from one facility to another
 Vertical: lower to higher level
 Horizontal: referred to similar facilities in different catchment
area
 Community

 BHS primary

 RHU primary Private Hospital

 MDH secondary

legend:
 Prov’l Hosp 2˚ and 3˚ standard referral flow

alternative referral flow

 Regional Center tertiary

INTER-LOCAL HEALTH ZONE
 ILHZ is based on the concept of the District Health System
 DHS-a generic term used by WHO to describe an integrated
health management and delivery system based on a defined
administrative and geographical area
INTER-LOCAL HEALTH ZONE
 It has a defined catchment population w/ in a defined
geographical area
 It has a central or core referral hospital and a # of primary
level facilities such as RHUs and BHSs
 It covers not only gov’t health services
 It includes all other sectors involved in health care delivery
ILHZ: COMPONENTS
 People
 Boundaries
 Health facilities
 Health workers
ILHZ: CATCHMENT POP’N: 165,000

Municipality 1
2 RHUs

Municipality 2 Central
Municipality 3
3 RHUs Hospital
3RHUs

NGO
HEALTH SECTOR REFORM: UNIVERSAL
HEALTH CARE
 UHC(kalusugang pangkalahatang) a.k.a. Aquino health
Agenda
 The latest in a series to bring about health sector reform
 It was built upon the strategies of 2 previous platforms of
reform:
 Initial HSRA (1999-2004)
 FOURmula 1 for health ( 2005-2010)
 Planned for implementation until 2016
HEALTH SECTOR REFORM: UNIVERSAL
HEALTH CARE (RATIONALE)
 HSR intended to bring about equity in health service delivery
 Survey data show; has not been achieved as of yet despite HSR of
1999
 DOH & PhilHealth – highlighted the need to improve health
related financial risk protection among Filipinos
 PhilHealth benefit delivery was found to be the lowest among the
target population.
HEALTH SECTOR REFORM: UNIVERSAL
HEALTH CARE (RATIONALE)

The concern on inequitable access

to health resources has not been
resolved( DOH, 2010)
UHC: RATIONALE
 MDG 4 target:
 To reduce MMR from 209/100k LB in 1990 to 52/100k LB
by 2015.
 Accdg to preliminary 2009 FHSIS report, the country had
64/100k
 Short span of time to 2015; attainment of MDG is difficult
UHC: RATIONALE
 MDG target:
 Decrease infant/child mortality rate
 From 80/100k in 1990, data shows @ 2008 it reduce to
32/100k
 There is a high probability to achieve MDG 5 (NEDA,2010)
 UHC was launched thru AO 2010-0036
UHC: GOALS AND
OBJECTIVES
 Directed towards ensuring the achievement of the health
system goals of:
 Better health outcomes
 Sustained health financing
 Responsive health system
 Ensuring all Filipinos esp. the disadvantaged group, have
equitable access to affordable health care
UHC: STRATEGIC THRUSTS
 Financial risk protection thru expansion in NHIP
enrollment and benefit delivery

 Improved access to quality hospitals and health care

facilities

 Attainment of the health related MDG(DOH,2010)

UHC: STRATEGIC THRUSTS (6 INSTRUMENTS
OR BB)
 Health financing
 Service delivery
 Policy,standards and regulation
 Governance for health
 Human resource for health
 Health information
PRIMARY HEALTH
CARE
INTRODUCTION
Improvement in health quality in
population is a continuing challenge
for societies and government
HISTORY OF PHC
 9/6-12/1978: Internat’l Conference for PHC @ Alma Ata,
USSR
 It was initiated by the WHO and UNICEF
 Attended by 200 countries
HISTORY OF PHC
 Alma Ata Declaration on PHC:
 Health is basic fundamental right
 There exist global burden of health inequalities among pop’ns
 Economic and social development-basic impt for full
attainment of health for all
 Governments have the responsibility for the health of their
people
HISTORY OF PHC
 PHC strategy was adopted in the Philippines by virtue of LOI
949 of 1979
 Philppines: the 1st country in Asia to embark on meeting the
challenge of PHC
 Prior to LOI which provided impetus to then MOH,
 Several HWs, NGOs,offering comty based health programs( rural
areas of visayas and mindanao)

 Applying the spirit of PHC

DEFINITION OF PHC
 According to Alma Ata Declaration:
 PHC 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 thru their full participation and 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
RATIONALE FOR THE DEV’T OF PHC
 Magnitude of health problems
 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other development
PHC: UNIVERSAL GOAL

Health for all.

PHC: MAIN OBJECTIVES
 Promotion of healthy lifestyles
 Prevention of diseases
 Therapy of existing conditions
PHC
Health in the Hands of
the People by 2020
(theme under LOI 949)
KEY ELEMENTS TO ACHIEVE “HEALTH FOR
ALL” (WHO)
 Reducing exclusion and social disparities in health (universal
coverage)
 Organizing health services around people’s needs and
expectations( HSR)
 Integrating health into all sectors (public policy reforms)
 Pursuing collaborative models of policy dialogue (leadership
reform)
 Increasing stakeholder participation
ALMA ATA DECLARATION: 8 ESSENTIAL
HEALTH SERVICES
 E- Education for health
 L- Locally endemic dse. control
 E- EPI
 M- MCH including responsible parenthood
 E- Essential drugs
 N- nutrition
 T- Tx of communicable & non- communicable dse.
 S- Safe water & sanitation
PHC: KEY PRINCIPLES
 Acessibility, affordability, aceptability, availability
 Support mechanisms
 Multisectoral approach
 Community participation
 Equitable distribution of health resources
 Appropriate technology
PHC: THE 4 AS
 Acessibility
 Refers to the physical distance of health facility
 Facilities: to be considered accessible, it must be w/in 30
mins from the comtys
 BHS are intended to provide accessible health services
PHC: THE 4 AS
 Affordability
 Is not only consideration of the individual or family’s
capacity to pay for basic health services
 It is also a matter of whether the comty or government can
afford these services( particularly public health)
 Out-of-pocket expenses for health care
 Actual cost to the family less the coverage of
insurance( PhilHealth)
PHC: THE 4 AS
 Acceptability