DMC COLLEGE FOUNDATION, INC.

NCM 104
Community Health Nursing 1

TOPIC CONTENT

1. Department of Health (DOH)

2. Local Health System and Devolution of Health Services

Department of Health

Vision:
"Filipinos are among the healthiest people in Southeast Asia by 2022. Asia by 2040"

Mission:
"To lead the country in the development of a Productive, Resilient, Equitable and People Centered
health system."
Goals:
"Better Health Outcomes, More Responsive Health System, More Equitable Health Care Financing"

Strategic Pillars
1. Financing
Health Financing
- To foster greater, better and sustainable INVESTMENTS in health
- PHIC (Philippine Health Insurance Corporation) through:
- NHIP- National Health Insurance Program DOH
- Contribution: 200 per month or 600 per quarterly
2. Health Service Delivery
- To ensure ACCESSIBILITY AND AVAILABILITY of health services
3. Governance
- To enhance HEALTH SYSTEM PERFORMANCE at national and local levels
T- Transparent
Efficient
Accountability
 4. Health regulation
- To ensure QUALITY AND AFFORDABILITY of health goods and services
"PLUS"
Performance Accountability

Values
Integrity, Excellence and Compassion

Quality Policy
The Department of Health, as the nation's leader in health, is committed to guarantee equitable
accessible and quality health services for all Filipinos.
The DOH, together with their partners, shall ensure the highest standards of health care in compliance
with statutory and regulatory requirements
And shall continually improve their quality management systems to the satisfaction of our citizens.

ROLES & Functions (EO 102)

1. Administrator of Specific Services
 Manage selected national health facilities, hospitals with modern & advanced facilities
 Administer direct services for emergent health concerns.
 Administer special components of specific programs ( TB, Schistosomiasis, HIV-AIDS)
 Administer health emergency response services, including referral & networking system for:
- Trauma
- Injuries
- Catastrophic events

2. Enabler and Capacity Builder

 Innovate new strategies in health
 Exercise oversight functions & monitoring & evaluation
 Ensure the highest achievable standards of quality health care

3. Leadership in Health
 Serve as the national policy & regulatory institution
 Provide leadership in:
- Formulation
- Monitoring
- Evaluation
 Serve as advocate in the adoption of health policies, plans & programs

While pursuing its vision, the DOH adheres to the highest values of work, which are:
1. Integrity – The Department believes in upholding truth and pursuing honesty, accountability,
and consistency in performing its functions.
2. Excellence – The DOH continuously strive for the best by fostering innovation, effectiveness and
efficiency, pro-action, dynamism, and openness to change.
 3. Compassion and respect for human dignity – Whilst DOH upholds the quality of life, respect for
human dignity is encouraged by working with sympathy and benevolence for the people in
need.
4. Commitment – With all our hearts and minds, the Department commits to achieve its vision for
the health and development of future generations.
5. Professionalism – The DOH performs its functions in accordance with the highest ethical
standards, principles of accountability, and full responsibility.
6. Teamwork – The DOH employees work together with a result-oriented mind set.
7. Stewardship of the health of the people – Being stewards of health for the people, the
Department shall pursue sustainable development and care for the environment since it
impinges on the health of the Filipinos.

Health Sector Reform Agenda

The Health Sector Reform Agenda (HSRA) describes the policies, public investments, and
organizational changes needed to improve the way health care is delivered, regulated, and financed in
the country.

Overriding goal of DOH

Describe the major SOP:
S- Strategies
O- Organizations
P- Policies

In 1994 the Philippines DOH took a bold step towards improving the performance of the health sector
by improving the way health services are being provided and financed.
This program of changed is known as Health Sector Reform Agenda. They are directed mainly at:
Increasing access – specially by the poor – to personal health services delivered by both public and
private providers.
Reducing the financial burden on individuals and families thru – UHC of NHIP
HSRA – was design to be implemented as a package – because the components are highly
interdependent.

FOURmula ONE for Health

The Fourmula One for Health:

 The Road Map for Health Sector Reforms in the Philippines 2005 – 2010
 Is the implementation framework for health sector reforms in the Philippines for the medium
term covering 2005-2010. It is designed to implement a critical health intervention as a single
package, backed by effective management infrastructure and financing arrangements
  This document provides the road map towards achieving the strategic health sector reform
goals and objectives of FOURmula ONE for Health from the national down to the local levels

 FOURmula ONE for Health - engages the entire health sector, including the public
and private sectors, national agencies and local government units, external development
agencies, and civil society to get involved in the implementation of health reforms. It is an
invitation to join the collective race against fragmentation of the health system of the country,
against the inequity of healthcare and the impoverishing effects of ill-health. With a robust and
united health sector, we can win the race towards better health and a brighter future for
generations to come

 In 2016, President Rodrigo Duterte highlighted his administration’s commitment to health

signifying that he wanted to make sure that “no one goes home without buying medicine.” The
revival of the Botika ng Bayan (BnB) was identified as one of the strategies to provide free access
to essential medicines. The DOH pushed for the revival of BNB in recognition of its potential to
improve access to medicines and health services which is strategically geared towards the
fulfillment of the Universal Health Care (UHC).

 The revitalized BNB shall be known as the FOURmula One Plus Botika ng Bayan (F1 Plus BNB)
which mainly targets government primary health facilities including the Rural Health Units
(RHUs) and Health Centers (HCs) in order to upgrade pharmacy services at the primary care level
and become government operated pharmacies. It aims to harmonize the management of
medicines (i.e., DOH program medicines and LGU medicines) at the primary care level under one
structure as an officially licensed pharmacy serving free medicines to Filipino patients. This also
formalizes the dispensing activities of RHUs, which by law must be licensed by the Food and
Drug Administration (FDA). All these in combination with a strong partnership between the LGU
and the DOH are being undertaken to ensure sustainable implementation of the BNB program.

 Likewise, the DOH partnered with the Philippine National Police (PNP) and the Armed Forces of
the Philippines (AFP) for the establishment of FOURmula One Plus Botika ng Bayani (BNBi)
outlets to provide essential medicines for the uniformed personnel and their dependents.

Goals of FOURMula ONE:

1. Better health outcomes
2. Equitable and sustainable healthcare financing
3. More responsive healthcare systems

3 Strategies in Delivering Health Services:

1. Creation of RHCDS PD 568 of 1976
RHCDS – Restructured Health Care Delivery System:
a. To strengthen the local health sectors.
b. To affect a more efficient and effective delivery care of health services in the country.
2. Management of Information Systems regulated by RA 3753: Vital Statistics Law
 3. Primary Health care regulated by LOI 949 (1984)

HEALTH CARE DELIVERY SYSTEM:

 The totality of all policies, facilities and all equipment, products, and all human resources and
services which address the health needs, problems and concerns of other people.

 The network of health facilities and personnel which carries out the task of rendering health
care to the people. (Tungpalan, 1981)

Health care system

- An organized plan of health services
Health Care Delivery
- Rendering health care services to the people

A Public Health Nurse does not function in a vacuum. She is a member of a team working within a
system. In order for the nurse to function effectively she has to understand the health care delivery
system wherein she is working because it influences her status and functions. She needs to properly
relate with the dynamics of the political, organizational structure surrounding her position in the health
care delivery system.

HEALTH CARE DELIVERY SYSTEM

Two Major Players

1. Public
- DOH
- LGU
2. Private
 What is RA 7160?
RA 7160: the Local Government Code
DECENTRALIZATION:
Transform the LGUs into SELF-RELIANT communities and active partners in the attainment of national
goals

Objectives for local health systems

1. Establish local health systems for effective and efficient delivery of health care services.
2. Upgrade the health care management and service capabilities of local health facilities.
3. Establish local health systems for effective and efficient delivery of health care services.
4. Upgrade the health care management and service capabilities of local health facilities.
5. Establish local health systems for effective and efficient delivery of health care services.
6. Upgrade the health care management and service capabilities of local health facilities.

INTER LOCAL HEALTH SYSTEMS/ZONE (ILHS/Z)

 Clustering of municipalities with defined population and geographical area

 a referral hospital, RHU, BHS

Composition of Inter-Local Health Zone (ILHZ)

a. People - 100,000 to 500,000

b. Boundaries- determines the accountability and responsibility of health care providers
c. Health facilities- district, emergency or provincial hospital as an integrated health system
d. Health workers- right unit of health providers is needed to deliver comprehensive health
services

In every province/municipality Local Health Board (Chaired) Local Chief Executive serve as advisory body
to the Sanggunian/local legislative council on health related matters.

RURAL HEALTH UNIT VS. BARANGAY HEALTH UNITS

Rural Health Unit Barangay Health Unit
Within municipality of 5,000 population Strategic area 3-5 km away from RHU
Complete Health Team Rural midwife only
Managed by MHO Acts as a satellite station
THREE LEVELS OF PROIMARY HEALTH CARE WORKERS

LEVEL I: Village/ Barangay Health Workers/Grassroots

 Non- professionals
 With honorarium only
 First contacts of the community and initial links of health care.
- Trained Community Health Workers
- Health Auxiliary Volunteer
- Traditional Birth Attendant
- Barangay health volunteers
- Barangay health workers

LEVEL II: Intermediate Health Workers

 PROFESSIONALS: 8
- Medical Officer (MO)-Physician
- Public Health Nurse (PHN)-Registered Nurse
- Rural Health Midwife (RHM)-Registered Midwife
- Dentist
- Nutritionist
- Medical Technologist
 Represent the first source professional health care.
 Attends to health problems beyond the competence of village workers.
 Provide support to front-line health workers in terms of supervision, training, supplies, and
services.
 Provide simple curative and preventive health care measures promoting healthy environment.
 Participate in activities geared towards the improvement of the socio-economic level of the
community like food production program.

LEVEL III: First Line Personnel

 Specialist
 TWO WAY REFERRAL SYSTEM
A two-way referral system need to be established between each level of health facility.

MULTI SECORAL APPROACH

INTERSECTORAL LINKAGES

 Primary Health Care forms an integral part of the health system and the over-all social and economic
development of the community. As such, it is necessary to unify health efforts within the health
organization itself and with other sectors concerned. It implies the integration of health plans with
the plan for the total community development.

Sectors most closely related are:

a. Agriculture
b. Education
c. Public Works
d. Local Government Units
e. Social welfare
f. Population Control
g. Private Sectors

 In the health sector, the acceptance of primary health care necessitates the restructuring of the
health system to broaden health coverage and make health service available to all.
 There is now a widely accepted pyramidal organization that provides levels of services starting with
primary health and progressing to specialty care.
 Primary health care is the hub of the health system.