Unit I.

The Philippine Health Care Delivery System: Introduction

What is health care delivery system?

 A health system, also sometimes referred to as health care system or as healthcare system
 is the organization of people, institutions, and resources that deliver health care services to meet
the health needs of target populations?
 In some countries, health system planning is distributed among market participants

The Major Players

The Philippine health care delivery system is composed of two sectors.

1. The Public sector –

 largely financed through a taxed based budgeting system at both national and local levels,
 health care is generally given free at point of service (although socialized user fees have been
introduced in recent years for certain types of services)
 Consists of the national and local government agencies providing health services.

 The DOH (Department of Health)

 The LGU (Local Government Units/Agencies)
PGH
THE Department of health
DOH – is the mandated lead agency at the national level (malaria and schistosomiasis} PGH
 A global leader for
1. attaining better health outcomes,
2. competitive and responsive health care system,
3. and equitable health financing.
 To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to
lead the quest for excellence in health.

 Has regional field office in every region and 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 communicable disease control, specifically for malaria and schistosomiasis.

 PGH (Philippine General Hospital) and other national government agencies providing health services
are also part of this sector.

The Local Health System:

 Local health System – run by the Local Government Units (with the devolution of health services)
 Provincial and district hospitals are under the provincial government, while the city/municipal
government manages the health centers/ Rural Health units(RHUs) and Barangay Health Stations.
(BHSs)
 In every province, city or municipality, there is a local health board chaired by the local chief
executive. The function is mainly to serve as advisory body to the local executive and the
sanggunian or local legislative council on health related matters.
2. The Private Sector
2.The Private sector – which largely market - oriented and where health care is paid through user
fees at the point of service.
 Includes for profit, and non- profit health providers.
Involvement includes:
 Providing health services in clinics and hospitals
 Providing health insurances
 Manufacture of medicines, vaccines, medical supplies, equipment and other nutrition
products
 Research and development
 Human resource development and other health –related services.

The Department of Health: Overview

A.1. The Constitutional Provision:

 The Department of Health is a major department of the government, the creation of

which is embodied in Article XIII, Section 11 and 12 of the 1986 constitution, to wit:

 “The state shall adopt an integrated and comprehensive approach to health

development which shall endeavor to make essential goods, health and social services
available to all the people at affordable cost. There shall be priority for the needs of
the underprivileged, sick, elderly disabled, women and children.”

 “The state shall endeavor to provide free medical care to the pauper. (Sec. 11)”
 “The state shall establish and maintain an effective food and drug
regulatory system and undertake appropriate health manpower development
and research, responsive to the country’s health needs and problems”
 A.2. The State Policy:
 The state policy provides that:
“The state shall protect the rights to health of the people and instill
consciousness among them” (Sec. 5, Article 2, Administrative code of 1987: Sec 3 of
Implementing the Local Government Code of 19191, DOH Rules and Regulations.)
The Mandate
 The implementing guideline for this constitutional provision was embodied in executive
order 119, which reorganized and mandated the DOH to:

“Be responsible for the formulation, planning, implementation and coordination of policies
and programs in the field of health. The primary function of the Department is the PROMOTION,
PRESERVATION, AND RESTORATION of the health of the people through the provision and delivery
of health services and through the regulation and encouragement of providers of health goods and services”

 The constitution articulates the Vision that Every Individual Filipino Has the Right to Health,
particularly the poor and the under privileged. To ensure the enjoyment of this right by all
citizens of the country, the state shall endeavor to make available all basic health and welfare
services.
Role of the DOH as a national Health Authority (Executive Order 102)
1. Leadership in health
 Serve as the national policy and regulatory institution from which the local government units, non-
government organizations, and other members of the health sector involved in social welfare and
development will anchor their thrusts and directions for health.
 Provide leadership in the formulation, monitoring and evaluation of national health policies, plans
and programs.
 DOH shall spearhead sectoral planning and policy formulations and assessment at the national and
regional level.
 Serve as advocate in the adoption of health policies, plans and programs to address the national and
sectoral concerns.

2. Enabler and capacity builder-

 Innovate new strategies in health to improve the effectiveness of health programs, initiate public
discussion on health issues and undertaking and disseminate policy research outputs to insure
informed public participation in policy decision making.
 Exercise oversight functions and monitoring and evaluation on national health plans, programs and
policies.
 Ensure the highest achievable standards of quality health care, health promotion, and health
protection
 Exercise oversight functions and monitoring and evaluation on national health plans, programs and
policies.
 Ensure the highest achievable standards of quality health care, health promotion, and health
protection

3. Administrator of Specific Services –

a) Manage selected national health facilities and hospitals with modern and advanced facilities
that shall serve as national referral centers (i.e. Special hospitals) and selected health facilities
at sub-national levels that are referral centers for local health systems. ( i.e. tertiary and
special hospitals, reference laboratories, training centers, centers for health promotion,
centers for disease control and prevention, regulatory offices among others.
b) Administer direct services for emergent health concerns that require new complicated
technologies that it deems necessary for public welfare; administer special components of
specific programs like tuberculosis, schistosomiasis, HIV-AIDS, in as much as it will benefit
and affect large segments of the population.
c) Administer health emergency response services, including referral and networking system for
trauma, injuries and catastrophic events, in cases of epidemic and other widespread public
danger upon the direction of the president and in consultation with the concerned LGU.

The Vision
 The DOH is the leader, staunch advocate and model in promoting HEALTH FOR ALL IN
THE PHILIPPINES.
 Filipinos are among the healthiest people in southeast Asia by 2022 and Asia in 2040.
Vision by 2030
A global leader for attaining better health outcomes, competitive and responsive health care system,
and equitable health financing

The Mission
 Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall
lead the quest for excellence.
 To lead the country in the development of a productive, resilient, equitable and people-
centered health system.
The DOH shall seek all ways to establish performance standards for human health resources; health
facilities and institutions; health products and health services that will produce the best health systems for
the country. This is in pursuit of its constitutional mandate to safeguard and promote health for all Filipinos
regardless of creed, status or gender with special consideration for the poor and the vulnerable, who will
require more assistance.

Universal Health Care : TO ADDRESS INEQUITY IN THE HEALTH SYSTEM

Universal Health Care (UHC),

 also referred to as Kalusugan Pangkalahatan (KP), is the “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
 It is a government mandate aiming to ensure that every Filipino shall receive affordable and
quality health benefits.
 This involves providing adequate resources – health human resources, health facilities, and
health financing.

The Thrusts of UHC

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 Sustainable Development Goal (as successors of health-related Millennium
Development Goals (MDGs).

The National objectives for Health;

1. Improve the general health status of the population.
 Reduce IMR, CMR, MMR
 Reduce fertility rate
 Increase life expectancy and quality life years
2. Reduce morbidity and mortality from certain diseases
3. Eliminate certain diseases as public health problems.
 Schistosomiasis, malaria, filariasis, leprosy, rabies, measles, tetanus
 Diphtheria, pretussis, Vit.A deficiency, iodine deficiency disorders
4. Promote healthy lifestyle and environmental health.
 Healthy diet and nutrition
 Physical fitness
 Personal hygiene
 Mental hygiene and less stressful life
 Prevent risk taking – behaviors
5. Protect vulnerable groups with special health and nutrition needs.
 The child, adolescent and youth, women, the elderly
 The indigenous people, the migrant workers,
 The different abled persons, the rural and urban poor.
6. Strengthen national and local health systems to ensure better health service delivery.
7. Pursue public health and hospital reforms.
8. Reduce cost and ensure the quality of essential drugs.
9. Expand the coverage of social health insurance.
10. Mobilize more resources for health. Improve efficiency in the allocation
Guiding Principles and values advocated by the DOH to achieve its mission:
 Health is a basic human right
 The greatest good for the greatest number.
 Correction of social inequities.
 Health care is a continuum.
 Belief in the consultative process towards decision and action.
 The reference point for all program are the people with bias for the poor.
 The business of government is too important and too complex for government to do alone.
 The concept of primary health care embodies need for self-sufficiency.
 Nationalism requires a certain set of values like intellectual preparedness, cerebral astuteness and
political will.
 The need to provide honest information to the public “telling it as it is, even if it hurts.”
 Honesty and professionalism are of prime importance in a job.
 Belief in DOH being the forefront of government activities and that DOH is part of a larger group.
 The health professional, because of the unique position he holds in the community, is expected to
lead not only on health matters but also in other community concerns.

The Organizational Structure of the DOH

 The Department of Health is headed by the Secretary of Health.
 It consists of the following:
1. Central Office or Department Proper
 Office of the Secretary
 Office of the chief of Staff
 Office of the Public Health Services
 Office of the hospital and Facilities Services
 Office of the Standards and Regulation
 Office of Management Services
 Executive Committee for National Field Operations

The National Field Operations is composed of the following:

1. Teaching /training hospitals and medical centers
2. Regional health offices;
 Regional hospital/ Medical centers headed by the regional director
 Provincial Health Offices headed by the provincial health officer.
 Each Provincial health office has several District health offices headed by the
District Health Officer
 Each District Health Office has several Rural Health Units in each catchment
area headed by the Municipal Health Officer.
 Each RHU has several BHS covering a total population of 5,000; managed by a
Rural Health Midwife
FUNCTIONS of the Different Levels of offices:

LEVEL FUNCTIONS
1. National/ Central office 1.Statement of policies and
guidelines in the
implementation of health
services
2. Formulation of the NHP
3. Supervision of other tertiary
hospitals and medical centers
2. Regional / Regional Center for Health 1. Interpretation of the NHP to fit to the
Development existing health problems in the region
2. Provides technical supervision to the
IPHO
3. Provides human resource development
Provincial/ IPHO 1. Coordinates programs
and projects of the
Department
2. Prepares health plan for
the province
3. Provides technical
support within the
district and municipal
health office.
4.Distrct Health Office 1. Coordinates programs and project of
the department
2.Technical supervision of the
RHU
5.Rural Health Unit .1. Prepares the Municipal
Health Plan
2. Implements program thrusts
of the department and
evaluate community
health services at their level
1. Rural Health Physician/Municipal Health Officer - heads the Rural Health Unit, stationed at the
Main Health Center in the municipality or Poblacion

2. The Public Health Nurse -acts as the supervisor of the midwife in the delivery of nursing services

3. The Rural Health Midwife -The front line service provider, responds directly to the health needs
and problems of the clients/ people.
Makes sure that all the DOH services are available to the people in the catchment area.
Mans the BHS, covering a catchment area of 5,000 population

4. The Rural Sanitary Inspector- Attends to the environmental problems/ needs of the community.

5. Other members of the health team: Dentist and dental Aid, Medical technologist

The Levels of Health Care Services and the Referral System

There are three levels of health care facilities/Services in the DOH. These are the
following:
1. Primary health care facilities:
Barangay Health Stations
Rural Health Unit
Community Hospitals and Health Center
Private practitioners / Puericulture Centers

 Are usually those at first or initial contact with the client. The initial link in the health chain.
 Provide elementary/ basic preventive and curative health care and measures to promote a
healthy environment.
 Focus on treatment of prevalent diseases in the community

2. Secondary
 Emergency / District Hospitals
 Provincial/ City Health Services
 Provincial/ City Hospitals
 Provides back up care to primary services for those needing hospitalization.
 Provide support to the frontline health workers in supervision, training, referral services
 Establish linkages with other sectors to promote health and prevent disease

3. Tertiary
 Regional Health Services
 Regional Medical Centers/ Training Hospitals
 National Health Services/Medical Centers
 Teaching Training Hospitals
 Provides back up health services for cases that needs specialized care, requiring more
sophisticated diagnostic facilities and hospitalization.
 Establish close contact with the village and intermediate level of health workers for
continuity of health care.

Various categories of health workers make up the primary healthcare team. They vary depending upon:
a. Available health manpower resource.
b. Local health needs and problems.
c. Political and financial feasibility
 Health problems beyond the capability of the primary health care units and beyond the competence
of primary health care workers are referred to an intermediate health facility usually the Rural
Health Unit (RHU).

 At the district level, a first line hospital, may be a community hospital, attends to cases needing
hospitalization.
 Higher levels of health services at the provincial, regional and national levels, provide secondary or
tertiary care to complement the health care given at the district and peripheral levels.
 The higher the level the more specialized is the care handled by trained personnel and the more
sophisticated the equipment. The care is provided by a suitable health facility on the basis of health
need.
 There is “better utilization of scarce resources”

Referral within the RHU:

 The Rural health midwife ( BHS), the frontline health care provider, refers cases beyond her
competence to the main health center (RHU)- to the PHN.
 The nurse attends to the patient, if not within her competency refers the patient to the Physician, the
Municipal Health Officer.
 Note that there are three levels of care within the RHU.

Prepared by:

Prof Helen B. Gumba, RN, MPH,MAN

Rosita B. Cabal, RM, RN