JEZREL E.

FABRIGAR, RM, BSM, MGM

ASSISTANT PROFESSOR III
 1. POLITICAL
 2. CULTURAL
 3. HEREDITY
 4. ENVIRONMENT
 5. SOCIO-ECONOMIC
- involves one’s leadership how he/she rules, manages
and other people in decision making

1. Safety – the condition of being free from harm,

injury or loss of authority or power

2. Oppresion – unjust or cruel exercise of authority or

power
3. Political will
– Determination to pursue something which is for the
interest of the majority.

4. Empowerment
– The ability of a person to do something
- Creating the circumstances where people can use their
faculties and abilities at the maximum level in the pursuit
of common goals.
- relating to the representation of non-physical traits, such
as values, beliefs, attitudes and customs shared by a
group of people and passed from the generation to the
next.
1. Practices – a customary action usually done to
maintain or promote health like use of anting-anting and
lucky charms.
2. Beliefs – a state or habit of mind wherein a group of
people place into something or a person
- The genetic transmission of traits from parents to
offspring: genetically determined
- The sum of all conditions and elements that make up the
surroundings and influence the development of the
individuals
- refers to the production activities, distribution of and
consumption of goods an individual
It is large, complex, multi-level and multi-disciplinary.”

“ the totality of all policies, facilities, equipment, products,

human resource and services which address the health
needs, problems and concerns of the people.
This chapter delineates the health care delivery
system in the Philippines, beginning with the World
Health Organization (WHO); as this specialized
agency of the United Nations (UN) provides global
leadership on Health matters.
 In the Philippines, health services are provided by the
government and the private sector – for profit as well as
nonprofit, with latter frequently referred to nongovernmental
organizations (NGO’s).
 By the virtue of the mandate Local Government code R.A
7160 – should have an operating mechanisms to meet the
priority needs and service requirements of their communities
 The World Health Organization is a specialized agency of
the United Nations that is concerned with international
public health. It was established on 7 April 1948, and is
headquartered in Geneva, Switzerland. The WHO is a
member of the United Nations Development

 Since then April 7 has been celebrated each year as

World Health Day
1. Providing Leadership on matters critical to health and
engaging in partnerships where joint action is needed.
2. Shaping the research agenda, and stimulating the
generation, translation, and disseminating valuable
knowledge
3. Setting norms and standards and promoting and
monitoring their implementation
4. Articulating ethical and evidence-based policy options
5. Providing technical support, catalyzing change, and
building sustainable institutional capacity
- Is the agency mandated to lead the health sector towards
assuring quality health care for all Filipinos.
- Serve as the main governing body of health services in
the country
- Provides guidance and technical assistance to LGUs
through the center for Health Development in each of the
17 regions.
- Francisco Tiongson Duque III
 Its mandate is to develop national plans, technical
standards, and guidelines on health. Aside from being the
regulator of all health services and products, the DOH is
the provider of special tertiary health care services and
technical assistance to health providers and
stakeholders.
Basically, the DOH has three major roles in the health
sector:
(1) leadership in health;
(2) enabler and capacity builder; and
(3) administrator of specific services.
1. Planning and formulating policies of health programs
and services.
2. Monitoring and evaluating the implementation of health
programs, projects, research, training and services
3. Advocating for health promotion and healthy lifestyles
4. Serving as a technical authority in disease control and
prevention
5. Providing administrative and technical leadership in
health care financing and implementing the National
Health Insurance Law
1. Providing logistical support to LGUs, the private sector
and other agencies in implementing health programs
and services
2. Serving as the lead agency in health and medical
research
3. Protecting standards of excellence in the training and
education of health care providers at all levels of the of
the health care system
1. Serve as administrator
2. Provides specific program components
3. Develop strategies for responding emerging health
needs
4. Provide Leadership in health emergency preparedness
and response services
Vision by 2030
A global leader for attaining better health outcomes,
competitive and responsive health care system, and
equitable health financing.

Mission
To guarantee equitable, sustainable and quality health for
all Filipinos, especially the poor, and to lead the quest for
excellence in health.
 Equity – equal health services for all no discrimination
 Quality – DOH is after the quality of service not the
quantity
 Accessibilty – DOH utilize strategies for delivery of
health services

Philosophy of DOH:
“Quality is above quantity”
1. PROFESSIONALISM
2. RESPONSIVENESS
3. INTEGRITY
4. COMPASSION AND RESPECT FOR HUMAN DIGNITY
5. EXCELLENCE
Are members of the health team who are professionals namely:
 Medical Officer (MO) – Physician
 Public Health Nursing (PHN) – Registered Nurse
 Rural Health Midwife (RHM) – Registered Midwife
 Dentist
 Nutritionist
 Medical Technologist
 Pharmacist
 Rural Sanitary Inspector (RSI) –must be a sanitary engineer
Provincial Governments
are responsible for administration for Provincial and
District Hospitals

Municipal / City Governments

are in charge of primary care through RHU’s / CHO’s or
health centers.
• Satellite outposts known as Barangay Health Stations
(BHS’s)
- Provide health services in the periphery of the
municipality or city.
Administrative Order – A.O 2012 – 0012
- Rules and Regulations governing the new
classification of hospitals and other health facilities
in the Philippines.
HOSPITALS OTHER HEALTH FACILITIES
GENERAL A. PRIMARY CARE FACILITY
B. CUSTODIAL CARE FACILITY
LEVEL 1
C. DIAGNOSTIC/THERAPEUTIC
LEVEL 2
LEVEL 3
(TEACHING/TRAINING)

SPECIALTY D. SPECIALIZED OUTPATIENT

FACILITY
- are broadly classified as General or Specialty hospitals.

General Hospitals – provides services of all kinds of

illness, injuries or deformities as define it as
Level 1, Level 2 or Level 3.

Specialty Hospital – offers services for a specific disease

or condition or type of patient such as children, the elderly,
women (DOH, 2012a)
 CATEGORY A. (Primary Care Facility)
- a first-contact health care facility that offers basic services
including emergency services and provision for normal deliveries.
1. Without in-patient beds
*Health Centers, Out-patient Clinics and Dental Clinic

2. With in-patient beds- a short-stay facility where the patient spends

on the average of one to two days before discharge
* Infirmaries and Birthing (Lying - In) facilities
- A health facility that provides long-term care, including basic
services like food and shelter, to patients with chronic
conditions requiring on going health and nursing care due to
impairment and a reduced degree of independence in activities
of daily living and patients in need of rehabilitation.
* Psychiatric facilities, Substance/drug abuse treatment and
rehabilitation centers, sanitaria/leprosia and nursing homes
- A facility for examination of the human body, specimens from the
human body for the diagnosis, sometimes treatment of disease or
water for drinking water analysis. The test covers the preanalytical,
analytical and post analytical phases of examination.
1. Laboratory facility
a. Clinical Laboratory e. Newborn screening laboratory
b. HIV testing Laboratory f. Laboratory for drinking water
c. Blood service facility analysis
d. Drug testing laboratory
2. Radiologic facility
a. X – ray
b. CT –scan
c. Mammography
d. MRI
e. Ultrasonography
3. Nuclear Medicine Facility
- Regulated by the Philippine Nuclear Research Institute utilizing
applications of radioactive materials in diagnosis, treatment or
medical research with the exception of the use of sealed radiation
sources in radiotherapy as in
1.External Beam (Teletherapy)
* most common type using machine
2. Internal Radiation (Brachytherapy)
* implants (Temporary/permanent) client is radioactive
- Facility that performs highly specialized procedures on an
outpatient basis
Examples:
A. Dialysis Clinic
B. Ambulatory Surgical
C. Clinic Cancer Chemotherapeutic center/clinic
D. Cancer radiation facility
E. Physical Medicine and
F. Rehabilitation center/clinic
 - commonly known as a “HEALTH CENTER”
- A primary level health facility in the municipality
- The focus of the RHU/CHO is Preventive and Promotive
Health Services and the Supervision of BHS’s under its
jurisdiction

- “1 RHU: 20,000 population”- recommended ratio to

catchment population
1 RHU: 20,000 population

HEALTH PROFESSIONALs POPULATION

1 RURAL HEALTH PHYSICIAN/MHO/CHO 20,000
1 RURAL HEALTH MIDWIFE 5,000
1 RURAL HEALTH NURSE 20,000
1 MED.TECH 20, 000
1 RURAL SANITARY INSPECTOR 20,000
1 DENTIST 50,000
1 NUTRITIONIST 20,000
1 BHW 20 HOUSE HOLDS
- The BHS is the first-contact health care facility that offers basic
services at the barangay level
- It is the satellite station of the RHU/CHO
- It is manned by volunteer Barangay Health Workers (BHW)
under the supervision of the Rural Health Midwife (RHM)
- heads the health services at the municipal level and carries out the
following roles and functions:

1. Administrator of the RHU/CHO

- Prepares the municipal health plan and budget
- Monitors the implementation of basic health services
2. Community Physician

- Conducts epidemiological studies

- Formulates health education campaigns on disease prevention
- Prepares and implements control measures or rehabilitation plans

3. Medico-legal officer of the municipality

1. Manages the BHS and supervises and trains the BHW
2. Provides Midwifery services and executes health care
programs and activities
3. Conducts patient assessment and diagnosis for referral or
further management
4. Performs health information, education and communication
activities
5. Organize the community
6. Facilitates Barangay health planning and other community
health services
1. Supervises and guides all RHM’s in the municipality
2. Prepares the FHSIS quarterly and annual reports of the
municipality for submission to the Provincial Health Office (PHO)
3. Utilizes the nursing process in responding to health care
needs, including needs for health education and promotions of
individuals, families and catchment community
4. Collaborates with the other members of health team,
government agencies, private business, NGO’s and peoples
organizations to address the community’s health problems
3 LEVELS OF TRAINING

1. GRASSROOT/VILLAGE:
Includes Barangay Health Volunteers (BHV) and Barangay Health
Workers (BHW)
Non professionals, didn’t undergo formal training, receive no salary but
are given incentive in the form of honorarium from the local government
since 1993
2. INTERMEDIATE
These are professionals including the 8 members of the PHW’s
3. FIRST LINE PERSONNEL
The Specialist
- are considered as the interface between the community and the
RHU
- They are trained in preventive health care with a strong emphasis
on maternal and child care, family planning, and reproductive
health, nutrition and sanitation
- They are also equipped with basic skills for prevention and
management of common diseases.
- They assist in providing basic services at the BHS and the RHU.
- Are accredited by the local health board according to DOH
guidelines, although they carry the status of volunteers
- was enacted to bring about genuine and meaningful local
autonomy.
- This will enable local governments to attain their fullest
development as self-reliant communities and make them
more effective partners in the attainment of national goals.
- It mandates the devolution of basic services from the National
to LGU’s
*DEVOLUTION – refers to the act by which the national
government confers power and authority upon the various
LGU’s to perform specific functions and responsibilities
• Provincial Health Boards
• City/Municipal Health Boards
• Barangay Health Boards

• The chairman of the board is the local executive ???

• The vice-chairman of the board ???
• Who is the chairman in Barangay Health Board ???
 Chairman of the committee on health of the Sanggunian
 Representative from the private sector or NGO involved
in health services
 Representative of the DOH
1. Proposing to the Sanggunian annual Budgetary
allocations for the operation and maintenance of health
facilities and services within the
province/city/municipality
2. Serving as an advisory committee to the sanggunian on
health matters
3. Creating committees that shall advise local health
agencies on various matters related to health services
operation
- Implemented since 1992, devolution has brought
decision making and accountability on basic government
services closer to the people.
REFERRAL – is a set of activities undertaken by a health
care provider or facility in response to its inability to
provide the necessary health intervention to satisfy a
patient’s need.
* ensures the continuity and complementation of health
and medical services
- It usually involves movement of patient from health
center of first contact and the hospital at first level. When
hospital intervention has been completed, the patient is
referred back to the health center. This account the term
two-way referral system
 Internal referrals – Occurs within the health facility, from one
health personnel to another.
Example:
from RHM to PHN to MHO
 External referrals –is a movement of a patient from one health
facility to another, it maybe vertical, where the patient referral
may be from a lower to higher level of health facility or the other
way round. The referral may also be horizontal, where the patient
is refered between similar facilities in different catchment areas.
LEGAL BASIS OF THE INTER-LGU COOPERATION
ARTICLE X SECTION 13 OF THE CONSTITUTION
“Local Government Units may group themselves,
consolidate or coordinate their efforts and resources for
the purpose commonly beneficial to them in accordance to
the law.”
LOCAL GOVERNMENT CODE 1991 SECTION 33
“This allows for Inter-LGU cooperation to occur
through Memoranda of Agreement for mutually beneficial
purposes, with agreed contributions of staff, financial and
capital resources in whatever manner that suits the LGU
concerned.”
As stated earlier
* Devolution has resulted in a fragmented health care system and segregation of
public health services among different LGU’s.
* Referral System – functioning within the context of the Inter-local Health Zone
(ILHZ)
 Is based on the concept of the District Health System, a
generic term used by the WHO to describe an integrated
health management and delivery system based on a
defined administrative and geographical area
 It has central or core referral hospital and a number of
primary level facilities such as RHUs and BHSs.
 The ILHZ does not only cover government health
services but includes all other sectors involved in the
delivery of health services
1. PEOPLE
2. BOUNDARIES
3. HEALTH FACILITIES
4. HEALTH WORKERS
MEDICAL
REGIONAL
Comprehensive two-way
CENTER TERTIARY CARE
referral system
PROVINCIAL
HOSPITAL SECONDARY
TERTIARY CARE

MUNICIPAL PRIVATE
DISTRICT HOSPITALS
SECONDARY LEVEL
HOSPITAL
PRIMARY LEVEL
LEGEND
RHU
Standard referral flow –
PRIMARY CARE the usual route of
referral
BHS
Alternative Referral Flow –
the referral route taken
in exceptional cases
Community
 INTER-LOCAL
HEALTH ZONES MUNICIPALITY1
2 RHUs

MUNICIPALITY2 CENTRAL MUNICIPALITY3

3 RHUs HOSPITAL 3RHUs

DIAGRAMMATIC
REPRESENTATION NGO
OF AN ILHZ
 HSR are intended to bring about equity in health services
delivery, survey data show that this has bot been
achieved as of yet, despite health sector reforms since
1999.
 DOH and PhilHealth review highlighted the need to
improve health-reated financial risk protection among
Filipinos.
 More importantly, PhilHealth benefit delivery was found to
be lowest among the target population – the poorest
quintile
A. Financial Risk protection – Through expansion in NHIP or
National Health Insurance Program enrollment and benefit delivery
B. Improved access to quality hospitals and health care facilities
C. Attainment of the health-related SDG’s