Monica Angelique Ramos

2017-49021
Midterm Exam

ASEAN COUNTRIES

PHILIPPINES
Leadership & Governance  The Department of Health is the lead agency for Philippine health care.
 The management and delivery of health services “devolved” from DOH to locally elected provincial, city
and municipal government due to RA 7160.
Health Financing  Very high proportion of out-of-pocket spending
 Main fund sources are government, private, social health insurance, and others such as grants, aids, etc.
Regulations or Access to  Generally lax regulation with strong pharmaceutical/nutritiutical company lobbying influence (FDA lead
Medicines, Vaccines, agency)
Logistics  There is Generics Act since 1988 but compliance to it is still an issue
 The effect of devolution is that LGUs are left to budget for their supplies of medicines, resulting in great
variability among access to basic medicines across the country’s LGU. Same thing as with medical
instruments, devices and equipment.
Human Resources for Health  Some of the trained health workers categories do not correspond to international classifications due to
local and national demand
 There is underproduction in other categories such as doctors, dentists, medical technologists
 Unresolved issues on compensation, benefits, continuing education and training.
 Lack of incentives to choose the service-oriented career paths.
 DOH HRH efforts are Doctors to the Barrios, Nurses Deployment Program, Rural Health Midwife
Placement Program
Health Information  Poor integration and weak governance of national and local health information systems (Marcelo, 2005)
 Telecom infrastructure mostly concentrated in urban centers
 Unclear considerations for the role of IT in primary health care in the Philippines
 Lack of IT governance structures
 Existing DOH Information Gathering Systems: Allegedly computerized but still highly reliant on outdated
paper and pen systems in the frontlines
Service Delivery Public Sector:
 Financed through taxes
 Budgeting system is done at the local AND national level
 Health care service is ideally free at point of care
 Greatly impacted by Devolution
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2017-49021
Midterm Exam

Public Health:
 LGU (barangay, municipal/city, province) - direct delivery of public health services
 Vulnerable to political patronage DOH-"technical assistance"
 Advisory services for disease prevention and control
 Provides selected free medicines (NTP Filaria, Malaria, etc.) and vaccines
 DOH - ideally should be the primary health authority

Private Sector:
 Profit and non-profit providers
 Usually market driven
 Services are often not free (OOP schemes, Insurance, External funding)
 May not necessarily be needs-based (often abused/misused)

SINGAPORE
Leadership & Governance  The philosophy of Singapore’s healthcare system consists of three pillars. Firstly, the country is aimed
to build up a healthy population with preventive health cares and to encourage healthy lifestyles.
Secondly, Singapore also emphasizes personal responsibility towards healthy living through the “3M”
(Medisave, Medishield and Medifund) system. Lastly, the government has to keep the healthcare costs
down by controlling the supply side of the healthcare services and providing heavy subsidies at public
healthcare institutions.
 There are three main regulators in the system, Minister of Health (MOH), Central Provident Fund (CPF)
and Monetary Authority of Singapore (MAS).
Health Financing  Different tiers of subsidies depending on ability to pay.
 Medisave – A compulsory national medical savings scheme which individuals can tap on to co-pay for
their medical bills
 Medishield Life – A compulsory national medical insurance that covers citizens and permanent residents
from cradle to grave, including those with pre-existing conditions
 Medifund – An endowment fund which helps Singaporeans who are still unable to afford the subsidised
bill changes despite Medisave and Medishield coverage.
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2017-49021
Midterm Exam
Regulations of Access to  In the public health care sector, subsidies and financial assistance are provided to eligible patients for
Medicines, Vaccines, drugs included in the Standard Drug List (SDL) and Medication Assistance Fund (MAF).
Logistics  The MAF is a financial assistance scheme to help eligible Singaporeans pay for high-cost drugs that are
not on the SDL but have been assessed to be clinically efficacious and cost effective.
 Every child in Singapore is vaccinated from infectious diseases according to the National Childhood
Immunisation Programme.
Human Resources for Health  The Singapore Workforce Skills Qualifications (WSQ) that provides training programmes for healthcare
jobs, such as therapy support, pharmacy support and administrative support.
 In August last year, Healthcare ITM, SkillsFuture programme – developed in collaboration with
Nanyang Polytechnic – was launched to prepare pharmacy technicians for a higher level of
medication reconciliation and management, while also working with greater automation in
hospitals.
Health Information  The National Electronic Health Record System was started in 2011 in the country and the government
still spends about $15 million each year in maintenance costs.
 The country is now moving towards a new digital healthcare model by moving healthcare information
to the cloud. The project, named hCloud, will cost $37 million in the first 10 years of operations. There
are also plans to use data and analytics to assist in decision making at point of care as well as by the
Ministry of Health for national planning.
Service Delivery  Provides the Sinagporeans the primary healthcare, hospital care, long-term care and other integrated
care.
 Has an island network of outpatient polyclinics and private medical practitioner's clinics to provide
primary medical treatments, preventive healthcare as well as health education.
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2017-49021
Midterm Exam
MYANMAR
Leadership & Governance  The Ministry of Health (MOH) is the major organization responsible for raising the health status of the
people.
 The MOH is responsible for planning, financing, administrating, regulating and providing health care; it
is headed by the Minister assisted by two deputy ministers.
Health Financing  The major sources of finance for health services is the government.
 Out of pocket expenditure is the main source.
 Government has increased health expenditure yearly.
 In 2015, their government officially announced the nation-wide health insurance policy.
 1954 Social Security Act by the Ministry of Labor – free medical treatment, cash benefits, and
occupational injury benefits
Regulations or Access to  Since 2011 the drug supply has dramatically changed from a centrally controlled “push” system to a
Medicines, Vaccines, decentralized “pull” system and government medicines expenditure has increased from less than 0.2
Logistics USD/person/year to about 3 USD/person/year.
 In 2015, the complete vaccination coverage rate of only 55% among 12–23-month-old children, which
is lower than the estimated rate from routine administrative coverage.
Human Resources for Health  Although the number of health workers in Myanmar increased, it was still far below the global standard
of 2.28 health workers (doctors, nurses and midwives) per 1000 population.
 Training of health workers is usually conducted by the MOH Department of Medical Science (DMS),
which is also responsible for setting educational standards and revalidating qualifications to ensure
medical competency.
Health Information  The current Health Information System is based on having the concept of a minimum essential data set
to reduce the workload related to data management by the Basic Health Staff (BHS).
 Data are collected manually by individual BHS using standardized forms on monthly, quarterly and
annual bases (depending on the nature of the data collected), and collated at the local facility.
 Introduction of an electronic information system was one of the measures identified to strengthen the
information system.
Service Delivery  Public health services in Myanmar are delivered to the communities by rural health centres (RHCs) and
sub-rural health centres (Sub-RHCs) through corresponding township, district, and region and state
health departments that provide technical assistance and support.
 There is a need to bridge the gaps in service delivery between urban and rural communities and for
minority ethnic groups.
Monica Angelique Ramos
2017-49021
Midterm Exam

VIETNAM
Leadership & Governance  The public health care sector widely covers from central to grassroots levels.
 Central level (Ministry of Health) - Issuing law and other legal documents, making long-term plans and
strategy
 Provincial level - State-level department of health
 District level - General hospitals and preventive medicine centers at district level
 Commune level - Provide basic services: mother and child health care, family planning, treatment for
acute respiratory infections, immunization and treatment of common illnesses
Health Financing  Health insurance provided by the government includes 3 types: medical insurance, accident insurance
and a part of social insurance.
 Health care funds for the poor policy.
 High rate of out-of-pocket payments.
Regulations or Access to  Vietnam National Drug Policy - With two important goals: (1). Ensuring adequate supply of good quality
Medicines, Vaccines, drugs at affordable prices for the people; (2). Ensuring rational, safe and effective use of drugs.
Logistics  Pharmaceutical Law - The most important legal document on medicine because it not only
institutionalized the guidelines and policies of the Party and State over the activities of pharmacy, but
also created favorable conditions for Vietnam's pharmaceutical industry to integrate with countries in
the region and the world.
 The national expanded programme on immunization (EPI) is providing immunization to 10 vaccine
preventable diseases in Viet Nam.
Human Resources for Health  HRH policies are focusing on increasing salaries and allowances for health workers and on training for
difficult areas.
 The Government has a special programme for training health workers for disadvantaged regions.
 The Ministry of Health has approved HRH plans for all health services in general and for the examination
and treatment system in particular.
Health Information  Reports are mostly paper-based and manually created thus it is difficult to obtain the accurate data and
analyse.
 Health workers in lower level report monthly to higher levels thus it usally takes time.
 No official HRH information system exists and HRH information from health statistics is limited.
Service Delivery  High quality, advanced and well-equipped hospitals and clinics: clustered around major urban areas.
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2017-49021
Midterm Exam
 In rural areas, accessing quality healthcare is more challenging: lack the diagnostic equipment and
training to carry out some treatments.
 Project 1816: Satellite Hospital Program - Rotate experts from central-level hospitals through local
hospitals to train their colleagues on the procedures and devices necessary to provide more treatment
options locally

COMBODIA
Leadership & Governance  Central - Manages and leads entire health sector and public health administration is centralized
 Local (Provincial/Operational District) - Implements Health Strategic Plan, service delivery
 Professional associations - Medical Council role and professional association roles limited in regulation
and representing workforce
 Not-for-profits - Often collaborate with government on curative, education and promotion health
activities
Health Financing  Out of pocket payments (OOPS) are the main source of financing in health care.
 Foreign donors make up almost 50% of total government health spending.
 Basic service coverage of services (supply-side) achieved.
Regulations or Access to  1996 Law on the management of pharmaceuticals
Medicines, Vaccines,  The Ministry of Health (MOH) manages an essential drug list with pharmaceuticals required for the
Logistics minimum and complementary packages, as outlined in their respective guideline documents.
 The MOH procures and distributes these to drugs to operational districts, and then to the referral
hospitals and health centres.
 Drugs are dispensed at all public facilities and also in village outreach services, but most patient needs
are nevertheless obtained from private pharmacies or stalls, which are often linked to private clinics.
 This means the price of drugs is controlled by the practitioners, and there is incentive to prescribe
medication that may be unnecessary.
 All public health facilities, particularly health centres, experience lack of supplies due to procurement
and distribution problems, non-adherence to procurement schedules, inaccurate quantification, low
regulatory capacity and weak enforcement of the law.
Human Resources for Health  Rebuilding the health workforce has largely been a success following Khmer Rouge rule. There were
only 25 doctors in the country in 1979
 Improvement in staff numbers, quality and responsiveness required
Monica Angelique Ramos
2017-49021
Midterm Exam
 Current staff numbers: Approximately 21,000; Estimated 36000 health workers required by 2020
 Health Coverage Plan: Heavy reliance on nurses and midwives (70% of workforce) to achieve national
coverage of primary health care services
Health Information  Health Management Information System is maintained since 2010.
 Health Information System Strategic Plan is created to support national health plan.
 Electronic Health Records - Piloted and expected expansion
Service Delivery  Mixed health system
 Public sector - OOP and Donor funding, National & local governments, Decentralized system, Pro-
poor/Social health insurance focus
 Private sector - User fees at the point of service, Provide majority of curative care, Fragmented system
– loose regulation

MALAYSIA
Leadership & Governance  Ministry of Health – main provider of health care service in Malaysia
 The efficient use of limited resources has been achieved through an integrated national health care
system that encompasses both preventive and curative services.
Health Financing  Malaysia is a predominant tax financed system that the government contributes significantly towards
financing health services.
 Malaysian health services are ultimately funded through the general population by tax payments, and
contributions to EPF (Employee Provident Fund) and SOCSO (Social Security Organization).
 Immunization programs included in the Maternal & Child Health Programmes (MCH).
Regulations or Access to  Malaysia is the first country in the world who implements the use of a single security hologram label for
Medicines, Vaccines, all pharmaceutical products sold in the country.
Logistics  School-based immunization in Malaysia is part of a comprehensive School Health Programme (SHP) that
was established in 1967 as a joint programme between the Ministry of Health and the Ministry of
Education after some pilot testing.
 Gives free vaccination for non-Malaysian during outreach programme, mopping-up activities and
supplementary immunisation activities.
Human Resources for Health  Rural-urban maldristribution of doctors
 Public-private skewness of specialist
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2017-49021
Midterm Exam
 Specialist training – local master programmes, access to MOH hospitals for training, link to training
programs overseas
Health Information  National Health-Management Information System - national health database
 only 15.2% of Malaysian Public Hospitals implemented the Hospital Information System (HIS)
Service Delivery  Decentralization of health services
 Regional Health authorities given full responsibility to plan, deliver and monitor health services
 A dual health care system, with both the public and private health services, co-exists in Malaysia.
 The government provides health care services to the nation through public hospitals and health clinics
throughout the country

THAILAND
Leadership & Governance  Through Thailand’s many political turnovers, healthcare has remained a priority for the people and the
popularity of the national health insurance mechanism will secure its existence in the future.
Health Financing  Thailand’s financing for UHC is predominantly non-contributory, financed by general government
taxation.
 Its health financing system has provided universal coverage since 2001, based on three health insurance
schemes, namely the Social Health Insurance (SHI) for formal employees, the Civil Servants' Medical
Benefits Scheme (CSMBS), and the Universal Coverage Scheme (UCS) for the remaining population
Regulations or Access to  The E2 program is an approach to facilitate patient access to high-cost specialty medicines in Thailand.
Medicines, Vaccines,  Fourth National Drug Policy in 2011 - the government hopes to not only continue completely self-
Logistics funding its program but to also produce all of the vaccines needed for the program
Human Resources for Health  Thailand’s health workforce policies integrated recruitment, training, distribution, and rural retention
 The mandatory rural service policy was accompanied by financial incentives such as a hardship
allowance and incentives for out-of-hour work.
Health Information  eHealth Situation – Silo-type systems; little integration and interoperability; lack of national leadership
and governance body; inadequate health information system
Service Delivery  Provided via a mixed but predominantly public system
 The health centre is the first point of contact by the population and provides primary health care such
as basic treatment, prevention, and health promotion through nurses and public health workers.
 Physical access to health facilities across the country and strong financial protection made Thailand's
health system a success.
Monica Angelique Ramos
2017-49021
Midterm Exam
LAO PDR
Leadership & Governance  The National Growth and Poverty Eradication Strategy adopted by the Lao Government in 2003, focuses
on achieving a goal of “liberating the country from the status of a least - developed country” by 2020.
 The fundamental objective of the government’s health strategy is equality in access to health care thus
contributing to poverty reduction.
Health Financing  Under-funded - low per capita health-care spending, low Government funding.
 Inequitable - overly dependent on direct household expenditure for curative care.
 Weak in social protection - low coverage of the population.
 Inefficient and with low productivity
 There are social insurance programmes for those in the formal sector, the Civil Servants' Scheme (CSS),
and in the formal private sector, the Social Security Organization (SSO).
 In the informal sector, Community-based Health Insurance (CBHI) is progressively being expanded
Regulations or Access to  Limited access to medicines and the entrenched use of traditional treatments constrain the sector's
Medicines, Vaccines, growth.
Logistics  While the immunization efforts are moving forward positively, the demand for immunization remains
low in some settings specially in ethnic communities and remote areas.
Human Resources for Health  Shortage and maldistribution of the health workforce and inadequate skills of the health staff are the
main problems.
 Health Strategy to the Year 2020 - gives priority to improving employment capacity, increasing
deployment of skilled health workers to rural and remote areas, and enhancing the capacity of health
professionals through improved education and training in order to achieve the Millennium
Development Goals by 2015.
 Financial limitations remain a major obstacle to increasing the quantity and quality of the health
workforce.
Health Information  The DHIS2 open source platform has been utilised as the central data warehouse in line with the Health
Metrics Network architecture.
 It is employed first as a web-based data collection tool for the Health Management Information System
(HMIS) in the Ministry of Health (MOH), then as data warehouse for other surveys, with legacy data
supporting the analysis and development of national health statistics reports.
Service Delivery  The health-care delivery system is essentially a public system, with government owned and -operated
health centres and district and provincial hospitals.
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2017-49021
Midterm Exam

INDONESIA
Leadership & Governance  Ministry of Health - responsible for the formulation and implementation of national health and social
welfare policy and overall administration, and the coordination and management of the country’s
health and welfare system
 Health-Oriented National Development Approach envisioned as ‘Healthy Indonesia 2010’
Health Financing  Health financing in Indonesia is complicated by decentralization because direct payments of salaries and
capital costs by all levels of government clearly impact the hospital reimbursement schedules used by
insurers.
 The platform for universal coverage was established in 2004 with the introduction of a new health
program for the poor, Asuransi Kesehatan Masyarakat Miskin (Health Insurance for Poor Population) or
Askeskin, which was designed to increase access to, and the quality of, health services for the poor
Regulations or Access to  With regard to the distribution of medicines, it has been the government’s ambition to provide cheaper
Medicines, Vaccines, alternative unbranded generic drugs instead of patented branded products, which command premium
Logistics prices.
 Unbranded generic medicines, known in Indonesia as Obat Generik Berlogo (OGB), were once
predominantly produced by state-owned enterprises, but are currently also produced by several private
sector manufacturers.
Human Resources for Health  In order to improve maternal and child health and in conjunction with efforts to lower the maternal
mortality rate, midwife nurses are being deployed in the villages.
 Contract Doctor Programme
Health Information  The HIS includes data of health sector & other related development sectors (FP, Social Welfare,
Agriculture)
 The HIS integrates routine facility based data and non-routine community based data (survey, census):
Baseline Health Research, Facility Based Survey, Demographic Health Survey, National Socio-economic
Survey
Service Delivery  The Decentralization Act 1999 required a larger proportion of health spending to be allocated through
local government organizations, and this has resulted in the establishment of growing numbers of local
government health centers, as well as local health funds, supporting prevention and promotion projects.
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2017-49021
Midterm Exam
Health System County-specific Positive Negative
Building Blocks Example
Leadership & Thailand Although it is not among the world’s richest
Governance economies, Thailand succeeded in
introducing an affordable system that has
had a dramatic impact on the health of its
people. The Thai government has learned
from other health systems internationally,
and is able to use the sheer scale of the
Universal Coverage Scheme (UCS) as leverage
to gain purchasing power and secure
medicines at lower cost. And, of course, the
UCS was not made out of thin air: it came
after decades of wrangling the healthcare
infrastructure to meet demand, including
building up rural provision. The roll-out of
Thailand’s system is evidence that universal
healthcare provision is possible in lower-
middle income countries given the right
circumstances.
Health Financing Singapore Singapore have a health financing scheme Although Singapore’s healthcare system is
that would efficiently support all levels of comparatively more efficient than many
socioeconomic status. The endowment fund other countries, it still faces some problems.
which helps Singaporeans who are still At first, feedbacks gathered by CPF board
unable to afford the subsidised bill changes illustrate the insufficient coverage for post-
despite Medisave and Medishield coverage, retirement health care expenses. It is the
which is called Medifund, is an example of it. scenario particularly for the elderly above
85 years to whom Medishield provides no
coverage. In addition, Singapore’s safety
net — Medifund — is limited in its
commitments and administered at the local
level.
Monica Angelique Ramos
2017-49021
Midterm Exam
Regulations of Access Malaysia Malaysia is the first country in the world
to Medicines, who implements the use of a single security
Vaccines, Logistics hologram label for all pharmaceutical
products sold in the country.
Human Resources for Cambodia Heavy reliance on nurses and midwives
Health (70% of workforce) to achieve national
coverage of primary health care services
Health Information Myanmar Introduction of an electronic information
system was one of the measures identified
to strengthen the information system of
Myanmar. However, there have been a
number of constraints to overcome; namely
inadequacy and stability of electricity
supply, availability and speed of Internet
services and, most importantly, data
sensitivity in a setting where security
considerations overwhelm everything.
Service Delivery Singapore Singapore has attained one of the most
successful systems in terms of delivery of
excellent healthcare services as well as the
efficiency and effectiveness. It is achieved
through the joint responsibilities among
government, individuals and employers.
According to the World Health Organization
(WHO), Singapore’s healthcare system ranks
sixth globally and offers the 4th best
healthcare infrastructure in the world. It also
serves as the healthcare and medical hub of
the region and is arguably Asia’s best
healthcare system.