Learning Content

 System- a set of interrelated and interdependent parts that form a complex whole, and each of those
parts can be viewed as a subsystem with its own set of interrelated and interdependent parts.
 Health system- is an interrelated way in which a country organizes available resources for the
maintenance and empowerment of the health of its citizens and communities. It consists of
interrelated components in homes, educational institutions, workplaces, communities, the health
sector and other related sectors.
 Health sector- groups of services or institution in the community/country, which are concerned,
with the health protection of the population.
 Health Care Delivery System- the network of health facilities and personnel, which carry out the
task of rending health care to the people.
 Health Care System- an organized plan of health services. (Miller-keane,1987)
 Philippine Health Care System- is a complex set of organization interacting to provide an array of
health services.

Characteristics of a Health Care System Based On Primary Health

 The system should encompass the entire population on the basis of quality and responsibility.
 It should include components from the health sector whose interrelated actions contributed to
health.
 The essential element of PHC should delivered at the first point of contact between individuals
and health system.
 The other levels of health systems should support the first contact level to permit it to provide
the aforementioned essential elements on a continuing basis.
 AT the intermediate levels more complex problems should be dealt with more skilled and
specialized care as well as logistic support.
 The central level should coordinate all parts of the system and provide planning and
management expertise, highly specialized care, teaching for specialized staff.

Restructured Health Care Delivery System

The Restructured Health Care Delivery System (RHCDS) – is the combination of main health center
and satellite barangay health stations (BHS) which is essentially the basis for the implementation of the
new system.
THE PHILIPPINE HEALTH CARE SYSTEM
(Adopted from the national health plan (1995-2020) document:DOH)

A. STRUCTRURE OF THE HEALTH SECTOR

The Philippine Health Care Delivery System (PHCDS) has done through developmental
transformations over the decades as changing in its demographic, socio-economic and political,
environmental, cultural and technological context took place, recently, the infrastructure has move
 from a highly centralized system towards greater participation of local government and local
organizations in health administration and management. Also, it has taken a collaborative stance onto a
maturing partnership between the public and private stockholders. The health sector is composed
mainly of :
1. Government subsector
2. Private Institution,
3. Non-Government and;
4. People’s organization,
Altogether contributing to health in different roles with the ultimate goal of improving the health status
and the quality of life of the people.

GOVERNMENT SUBSECTOR
In the Philippines, it is composed of the Department of Health, and those government entities
serving as district health agencies by themselves such as the Philippine General Hospital, and
MediCare Commission, PhilHealth, or as health service arm of the departments like military hospitals
and mobile teams of the Department of National Defense (DND), the medical and dental services of
the DECS, the medical services of the penal institutions, the occupational health and the safety center
of the Department of Labor and Employment (DOLE) and the National Nutrition Council (NNC).

A. DEPARTMENT OF HEALTH (National Level) - The DOH is the principle government agency
mandated by the constitution for health promotion and protection. Prior to the implementation
of the Local Government Code, it has direct authority over the municipal, city provincial health
services and hospitals under the governors. It retained the regional offices and the number of
hospitals under its control.

 ROLE OF THE DOH

a. Ensuring equal access to basic health services;
b. Ensuring the formulation of national policies for proper division of labor and proper
coordination of operations among government agency jurisdictions;
c. Ensuring a minimum level of implementation of nationwide services regarded as
public health goods;
d. Planning and establishing arrangements of the public health system to achieve
economies of scale; and
e. Maintaining a modicum of regulations and standards to protect consumers and guide
providers.

B. LOCAL GOVERNMENT UNITS (Local Level)- With the devolution, the responsibility for health
promotion and protection has become a shared one between the LGU’s and the DOH. The two
major concern of both parties in this new role of LGU’s are:

1. How to strengthen the local government capability to manage and finance the services
devolve to them?
 2. How general and technical support ca be institutionalized o that in spite of the severance
of administrative authority of DOH over field operating units, integrated and
comprehensive health services through well-functioning network of health facilities can
be realized.

THE PRIVATE SUBSECTOR

The private subsector in health consist of both commercial and business organizations, non-
commercial organizations. Commercial organizations have a clear profit orientation and include
manufacturing companies and advertising agencies, private practitioners and private institutions like
private hospitals, health maintenance organizations, and medical/allied medical schools. The non-
commercial group is oriented toward social/development, relief and rehabilitation, and community
organizing: and this includes the socio-civic groups, religious organizations and foundations. Private
sub-sector involvements include:
1. Input provision which covers supplies and equipment/ treatment facilities.
2. Service delivery which includes a whole range of activities from case finding/
treatment and follow-up, counselling environment sanitation, to manufacture and sale of health
related goods.
3. Support activities mostly in the form of research, personnel training, project,
monitoring and evaluation, and development of IEG materials.
4. Financing through financing assistance that usually comes in the form of grants from
multilateral and bilateral agencies.

A. Commercial and Business Org. – have a clear profit orientation w/c includes manufacturing
companies, advertising agencies, private practitioners, & private institutions.

B. Non-Commercial Organizations – is oriented towards social development, relief and rehabilitation,

and community organizing. It includes; Socio-civic groups, Religious organizations, Foundations.

The private sub-sector is involved in the following:

1. Inputs provision - covers supplies, equipment/ treatment facilities
2. Service delivery – activities such as case finding/treatment & follow-up, counseling, manufacture &
sale of health goods.
3. Support activities – research, training, project monitoring and evaluation, development of EIC
materials
4. Financing – financial assistance such as grants from multilateral and lateral agencies

NON-GOVERNMENT ORGANIZATIONS
NGO’s play an important role in national and local development with emphasis on policy and
program reforms and people empowerment. NGO’s has consistently assumed the roles of catalysts,
advocates, facilitators and enablers in people development. Health NGO’s are those that are directly
involve in health care and in reforming the present health care delivery system. Some of the have
pioneered alternative approaches in health. Roles played by NGO’s include:
1. Direct delivery of health care services
2. Policy and legislative advocacy
3. Organizing to promote and protect economic and democratic rights, interest and
general health technology and PHC.
4. Research and documentation concerning important health issues such as appropriate
health technology and PHC.
5. Health resource development to respond to the severe lack of human resources
especially in depress areas.
6. Human right advocacy to uphold and advance the basic health and human rights of
the people, especially this marginalized by socio-economic factors such as urban poor, working
on strike, victims or torture, etc.
7. Relief disaster management which includes activities as recruitment and organizing
volunteers as disaster response teams, regular solicitation and stockpiling of needed medicine,
medical supplies, food and other essentials.
8. Networking to enable health BGO’s to learn from each other, maximizing their
resources, avoid duplication of work and respond to various issues simultaneously.

COMMUNITIES, FAMILIES AND INDIVIDUALS/ PEOPLES ORGANIZATION

The new emphasis of people participation in health development is indicated by four major
trends that will permeate into the 21st century.
1. Improving habits that actualize responsibility for health;
2. Increasing self-care that illustrates people’s self-reliance in areas not genuinely
requiring professional health;
3. More educated communities, increasing the demand for health service, both in
quantity and quality; and
4. The emphasis of the new paradigm of wellness, preventive medicine and holistic
care.

B. HEALTH FACILITIES
Health facilities are physically infrastructures that offer health services. These includes
hospitals, health centers, health stations, clinics and laboratories. The government, private sector and
NGO’s today operate health facilities.

1. HOSPITALS
The Philippine Hospital System is composed of government and privately owned hospitals. As
of 1994, there are 1809 hospitals of which the government operates 587 and 1222 are operated by the
private sectors. With the implementation of the Local Government Code of the 587 hospitals run by
DOH, 534 were devolved and 53 consisting of medical centers, special and regional hospitals were
retained. The hospitals are further subdivided into primary, secondary and tertiary categories according
to the level of care that id being offered. To ensure quality hospitals equipped with functioning
physical facilities and equipment has an effective organization and procedures. /system: highly quality
managerial resource, able to adopt and meet changing demands for hospital care.
2. HEALTH CENTER AND BARANGAY HEALTH STATIONS
Health center and Barangay Health Stations (NHS) are government facilities that are primarily
responsible for the delivery of basic health services to communities. They are the first point of contact
between the majority of the poor people and the health system.

3. PRIVATE CLINICS AND LABORATORIES

These provide service to a significant proportion of the population, particularly those belonging
to the middle and upper income classes. Most of these facilities are concentrated in urban areas where
they are highly in demand.

C. HEALTH SERVICES
The types of health services offered include a wide array of pro motive, preventive, curative
and rehabilitative services. Government health facilities provide preventive curative, and rehabilitative
services, while private sectors focus more in direct personal care that are curative and rehabilitative in
nature.

HEALTH SERVICE - are usually curative and rehabilitative. An expansion in the health service
delivered, now includes preventive, promoted service.

PRIMARY HEALTH CARE

Essential health services offered cater to specific population groups:

1. For infant and young child (fully Immunized Child, CDD’ CARI, information, dissemination, Target
Food Assistance Program (TFAP), micro-nutrient Supplementation.)
2. For you and adolescent ( National Program of Youth and Adolescent-1995)
3. For women ( Maternal and Child Health, Safe Motherhood, Responsible Parenthood)
4. For the elderly ( services geared toward reduction of chronic degenerative diseases)
5. For workers
6. For special communities (indigenous communities, victims in calamities and disaster, victim of
armed conflict)

D. HEALTH HUMAN RESOURCES DEVELOPMENT

HHR is the totality of skills, knowledge and capabilities available for national health
development. The health system requires different types of health personnel to properly and adequately
deliver the services necessary to promote and maintain the well-being of the people. HHR development
is a trial of activities.
1. Planning- enables the health system to rationalized the production and management of the health
personnel.
2. Production- is dependent in all levels of the education system, primary up to the university level.
3. Management- is dependent on the nature and character of the health system, the institutions offering
continuing education, current program of professional association and pervading professional attitudes.

E. HEALTH CARE FINANCING

Financing is form government. WHO recommended that 5% of the country gross national
production (GNP) shall be for health. However, it was placed only at government third party schemes
(medical program. PhilHealth, employee’s compensation commission), private sources (out of pocket
payment, Health Maintenance Organization-HMO- payment company financed health benefits;
community generated resources donations cash, materials and technical services from philanthropist or
doctors, external resources (WHO, UNICEF, USAID, JICA, GTZZ, CIDA, WORLD BANK,
UNFPA).
Health financing. The National Health Insurance Act of 1995 created the Philippine Health
Insurance Corporation (PhilHealth) to provide health insurance coverage for all Filipinos but enrolment
was not made compulsory. In 2013, it was amended, expanding the contributionbased national health
insurance program (NHIP) beyond formal employment to include the underprivileged, sick, elderly,
persons with disabilities (PWDs) and women and children. It strengthened the roles of the LGUs and
health providers in NHIP enrolment. PhilHealth serves as the national social health insurance agency
which purchases services from public and private providers on behalf of its members. However,
healthcare provision, health regulation, facility improvements and human resource deployment as well
as capacitation are still subsidized by the government, mainly through the DOH. Government budget
also flows through the health contributions of other central institutions such as DND, the Philippine
National Police (PNP), the University of the Philippines (all of which manage large hospitals), the
Philippine Charity Sweepstakes Office (PCSO), and the Philippine Amusement and Gaming
Corporation (PAGCOR). PhilHealth administers the National Health Insurance Program (NHIP) to
provide all Filipinos with financial risk protection. The government fully subsidizes the PhilHealth
premiums of the poor identified through the National Household Targeting Survey for Poverty
Reduction (NHTS-PR). Health system 8 uHC Chapter 1 Total health expenditure in the Philippines
grew by 39 percent to PhP655.1 billion from 2012 to 2016. Government expenditures likewise
increased owing to incremental revenues from sin taxes allocated for health, which led to a dramatic
increase in PhilHealth coverage from 84 percent in 2012 to 91 percent in 2016. Nonetheless, the huge
share of out-of-pocket (OOP) payment (52.2 percent) still dwarfed the share of government subsidies
(18.9 percent) and PhilHealth social insurance (16.7 percent) to total health expenditures, undermining
fi nancial protection.

Health governance and regulation. Th e enactment of LGC in 1991 led to dual governance in
health, with the DOH governing at the national level and the LGUs at the subnational level. Th e DOH
serves as the over-all steward and technical authority on health being the national health policy-maker
and regulatory institution. It is mandated to develop national plans, technical standards, and guidelines
on health. It is also in charge of licensing hospitals, laboratories and other health facilities through the
Health Facilities and Service Regulatory Bureau (HFSRB), and health products through the Food and
Drug Administration (FDA). PhilHealth automatically accredits DOHlicensed facilities. Meanwhile,
the Insurance Commission (IC) regulates and supervises the operations of private insurance companies,
and since 2015, of health maintenance organizations as well, except PhilHealth. Th e DOH also
coordinates government, private sector and development partner assistance on health and leverages
funds for improved health performance. The LGUs, on the other hand, are in charge of the delivery of
devolved primary and secondary health services at the subnational level. This is in response to the
fragmented archipelagic nature of the country and the uneven distribution of its population. LGUs
prepare plans, as well as manage and implement local health programs and services. The local health
board, which consists of selected and appointed members, enjoys advisory powers, planning authority
and responsibility for health services (Kelekar & Llanto, 2013). Various reforms were implemented to
address the weakened DOH political, technical and administrative control over the different levels of
healthcare brought about by devolution. The Health Sector Reform Agenda in 1999 supported the
development and strengthening of local health systems, facilitated the fiscal autonomy of government
hospitals, increased funding for priority public health programs and expanded NHIP coverage. The
FOURmula One (F1) for Health in 2005 sought to fill the remaining gaps in the health system not
addressed by previous reforms by leveraging central government funds to promote inter-LGU
collaboration in attaining desired health outcomes. In 2011, the Universal Health Care (UHC) or
Kalusugan Pangkalahatan became a policy goal, leading to the expansion of SHI coverage mainly due
to sin taxes earmarked for health, the introduction of no-balance billing (NBB) scheme for indigents,
and intensified support to health facility construction and enhancement.

The National Objectives for Health

(An excerpt from DOH (NOH) 2017–2022

NOH Serves as the medium-term roadmap of the Philippines towards achieving universal healthcare
(UHC). It specifies the objectives, strategies and targets of the Department of Health (DOH)
FOURmula One Plus for Health (F1 Plus for Health) built along the health system pillars of financing,
service delivery, regulation, and governance and performance accountability. This ultimately leads to
the three major goals that the Philippine Health Agenda aspires for:
(1) Better health outcomes with no major disparity among population groups;
(2) Financial risk protection for all especially the poor, marginalized and vulnerable; and
(3) A responsive health system which makes Filipinos feel respected, valued and empowered.

Its people-centered goals, objectives and targets were hewn from a series of dialogues and
consultations with policy- and decision-makers, implementers and other concerned officials from the
government, private sector, selected local government units and non-government organizations. By
vetting contentious policy issues, it was able to obtain direct technical and operational insights from
these stakeholders, which were considered in defining the medium-term health sector goals, targets,
strategies, and interventions across F1 Plus for Health pillars.
Strategic goals and targets
In response to the challenges identified in improving health outcomes and the health system, the DOH
pursues FOURmula One Plus (F1 Plus) for Health, which aims to provide Universal Health Care
(UHC) for all Filipinos in the medium to long term. The national policy on UHC espouses three
strategic thrusts: better health outcomes, responsive health system, and equitable and sustainable health
financing.
F1 Plus for Health has three strategic goals:
1. Better health outcomes- The health sector will sustain gains and address new challenges especially
in maternal, newborn and child health, nutrition, communicable disease elimination, and NCD
prevention and treatment. Improvements in health outcomes will be measured through sentinel
indicators such as life expectancy, maternal and infant mortalities, NCD mortalities, TB incidence, and
stunting among under-fiveyear-olds.
2. More responsive health system- The quality of health goods and services as well as the manner in
which they are delivered to the population will be improved to ensure people-centered healthcare
provision. This may be done through instruments that routinely monitor and evaluate client feedback
on health goods used and services received.

3. More equitable healthcare financing- Access of Filipinos, especially the poor and underserved, to
affordable and quality health goods and services will be expanded through mechanisms that provide
them with adequate financial risk protection from the high and unpredictable cost of healthcare. These
may include efforts to reduce catastrophic OOP payments, such as through public subsidies targeted
towards the poor.

Levels of health care facilities

1. Primary Level facilities- Health services at this level is offered to individuals in fair health and
to clients with disease in the early symptomatic stages.
 Include the rural health units, sub centers, chest clinics, malaria eradication units, etc.
Operated by the center for health development; clinics operated by the government,
private and non-government institutions.
2. Secondary Level Facilities- Offer services to clients with the symptomatic stages of the disease
which require moderately specialized knowledge and technical resources for adequate
treatment.
 Includes emergency/district hospitals, provincial/city health services and facilities.
3. Tertiary Level Facilities- Include the highly technological and sophisticated services offered
by medical centers and large hospitals. These are the specialized hospitals/institutions.
 Services offered at this level are not client afflicted with disease which seriously
threaten their health and which require highly technical and specialized knowledge,
facilities and personnel to treat effectively.
 Figure 3. A Pyramid Health Structure

TERTIARY LEVEL FACILITIES

(National & Regional Health Services
Medical Centers Teaching & Training
Hospitals)

SECONDARY LEVEL FACILITIES

(Provincial/city health services and
hospitals emergency and district hospital)

PRIMARY LEVEL FACILITIES

(Rural Health Units Community
Hospitals And Health Centers, Private
Practitioners, Peuriculture Centers
Barangay Health Station)
[Title]

Three Levels of Health care workers

AUXILIARY INTERMEDIATE ANCILLARY

1. Village (grassroot), Barangay 2. Intermediate level of health First line hospital workers
Health worker workers
( general medical practitioners
or their assistant
- Trained community health -MHO -Physicians with specialty
workers or health auxiliary -PHN -nurses, dentist
volunteer -RHM -Pharmacists, other health
-Volunteers or traditional Birth -RSI professional
attendant or healer or hilot
-First contact of community - First source of professional - higher source of professional
-provide basic healthcare health care healthcare
measures(simple curative and -attendt beyond health problems -back up health services for
preventive health care measures beyond the competence of cases that require
promoting healthy village workers hospitalization
environment) -provide support to front-line -establish close contact with
-Participate in activities geared health workers in terms of intermediate level health
towards the improvement of the supervision, training, supplies workers or village health
socio-economic level of the and services workers
community like food -
production program

Levels of Health Care Services

TYPE PRIMARY SECONDARY TERTIARY

Goal  Promotion of Health 1. Complication 1. Prevent further
 Prevention of Illness prevention disabilities
2. Diagnosis and 2. Rehabilitation
treatment
3. Emergency care

Health services are Offered at this level

offered to individuals in Offer services to clients
are for clients afflicted
fair health and clients with asymptomatic stages
with disease which
with diseases in the of the disease who
seriously threaten their
early symptomatic require moderately
health and which
stages specialized knowledge
require highly
and technical resources
technical and
and adequate treatment
specialized
knowledge, skills and
personnel
Workers Front liners/ Auxiliary Clinicians Clinicians, trainers,
intermediate specialty, nurses,
consultants
Facilities/Location BHS/Periculture centers Provincial/ City Health Special hospital,
RHU/ Com. Hospital Services and Hospitals regional and national
Private practitioner Emergency and District health services,
hospital medical centers
teaching and training
hospitals
Client Well- Early Sick Seriously ill with
diagnosis
Activities PHC; Health education, Case Finding/ contact Diagnosis, treatment,
immunization tracing, surveillance,
 provision of care, early rehabilitation
detection or screening

Figure 4. A two-way health referral scheme

The 3-tiered healthy systems call for close working relationship or personnel in the same level at the
various health levels. This ensures essential administrations, logistic and technological support. A two-
way referral system refers cases to the rural health team, who in turn refers more serious cases to either
the district or community hospital, then to the provincial, regional or the entire health care system. The
figure below shows a two-way referral scheme.
3rd 2ND
H H
E E
P A A
O L L
T T
P PUBLIC HEATH H H
U BARANGAY NURSE
L HEALTH MIDWIFE PHYSICIAN F F
STATION RURAL A A
A SANITARY C C
T INSPECTOR I I
I L L
O I I
T T
N
Y Y

Teaching and Learning Activities.

I. The class will be divided into 3 group. Each group will be given agency to interview on “what
each level of health care facility is doing to combat or fight the current pandemic. Given
emphasis on institution organization, Health worker role, Health facility available services, and
referral system (The Instructor will arrange the person ,time and date of the interview via video
call or zoom meeting)
1. Barangay Health Center/Station
i. Midwife/nurse
ii. Barangay officials
2. City Health Office
 i. Nurse
ii. MHO
3. Secondary Health Care Facility
II. During the zoom meeting students will be ask to present their assignment by group

Recommended Learning Materials & Resources For Supplementary

Reading.

I. Summary of the Philippine health care delivery system

II. https://nursinganswers.net/essays/the-philippine-health-care-delivery-nursing-essay.php
III. https://www.slideshare.net/roducado/philippine-health-care-delivery-system-69063192

Flexible Teaching Learning Modality (FTLM) Adopted

I. Zoom Meeting
II. TelEDUCATION
III. Facebook/messenger

Assessment Task
I. Recitation
II. Presentation
III. Group output
IV. Quiz on each concept

References
1. The basic of community health nursing by Monina H. Gesmundo
2. https://www.slideshare.net/jkonoroth/321-models-of-health