Health Sectors

Government Sectors
Non Government Sectors
Private Sectors

Factors that influence the health care delivery system:

 Health care reforms

Demographics

Globalization

Poverty and growing disparities

Social Disintegration
Global and Country Health Trend
 Shifts in demographic and epidemiological trends in
diseases.
 New technologies of health care, communication and
information.
 Existing and emerging environmental hazard

 Health reforms

A. World Health Organization

1. Millennium Developmental Goal ( MDG )
Target – Reduce global poverty and hunger
2. Sustainable Development Goals (SDG )
A collection of 17 global goals designed to be a "blueprint to achieve a
better and more sustainable future for all". The SDGs, set in 2015 by the United
Nations General Assembly and intended to be achieved by the year 2030.
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, Malaria and other diseases
7. Ensure environmental sustainability
8. Global partnership for development
1. No poverty 2. Zero hunger
3. Good health and well-being 4. Quality education
5. Gender equality 6. Clean water and sanitation
7. Affordable and clean energy 8. Decent work and economic growth
9. Industry, innovation, infrastructure 10. Reduced inequality
11. Sustainable cities and communities
12. Responsible production and consumption
13. Climate action 14. Life below water 15. Life on land

16. Peace and justice strong institutions

17. Partnerships to achieve goal
 Vision:( To be the leader of health for all in the
Philippines)Filipinos are among the healthiest people in
Southeast Asia by 2022, and Asia by 2040.
 Mission:( Guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor, and to lead the
quest for excellence in health.) To lead the country in the
development of a productive, resilient, equitable and
people-centered health system
 DOH Core Values
 1. Integrity 2. Excellence
 3. Compassion and respect for human dignity
 4. Commitment 5. Professionalism
 6. Teamwork
 7. Stewardship of the health of the people.
Historical Background:
 In 1944, President Manuel Roxas signed Executive

Order (E.O.) No. 94 into law, calling for the creation

of the Department of Health.
 On February 20, 1958, Executive Order 288

provided for the reorganization of the Department

of Health.
 With a shift to a parliamentary form of

government, the Department of Health was

transformed into the Ministry of Health on June 2,
1978 .
 On April 13, 1987, the Department of Health

was created from the previous Ministry of

Health .
 In 1987, the re-organization under Executive Order No. 119, which
placed under the Secretary of Health five offices headed by an
undersecretary and an assistant secretary.
 These offices are:
 Chief of Staff, Public Health Services, Hospital and Facilities
Services, Standard Regulations and Management Service
 In 1992, the full implementation of Republic Act No. 7160 or Local
Government Code. The DOH changed its role from one of
implementation to one of governance.
 In 1999, the functions and operations of the DOH
was directed to become consistent with the
provisions of Administrative Code 1987 and RA
7160 through Executive Order 102
Local Health Systems:
Refers to all organizations, institutions and resources
devoted to undertaking health actions to improve
health status of a population.(WHO)
 Health Financing

 National and local government

 Insurance
 User fees/out of pocket
 Donors
 Health Care Delivery System
 Health facilities
 Health human resource
 Utilization of health facilities
 Satisfaction with health facilities
 Governance and Regulation
 Enactment of LGC in 1991
 PhilHealth
 Insurance Commission
 Health Sector Reform Agenda in 1999
 FOURmula One for Health in 2005
 Universal Health Care in 2011
Devolution of Services
 Devolution

 Act by which the national government confers power and

authority upon the various LGUs to perform specific
functions and responsibilities
 In 1992, the Philippine Government devolved the
management and delivery of health services from
the National Department of Health to locally
elected provincial, city and municipal governments.
 RA 7160 (Local Government Code of 1991 ) to
"provide for a more responsive and accountable
local government structure instituted through a
system of decentralization
Classification of Health Facilities (
DOH AO-0012A )
Philippine Health Agenda
GOAL
Overview
May 1977 -30th World Health Assembly decided that the main
health target of the government and WHO is the attainment of a
level of health that would permit them to lead a socially and
economically productive life by the year 2000.
September 6-12, 1978 – First International Conference on PHC

in Alma Ata, Russia (USSR) The Alma Ata Declaration stated that
PHC was the key to attain the “health for all” goal
October 19, 1979 – Letter of Instruction (LOI) 949, the legal

basis of PHC was signed by Pres. Ferdinand E. Marcos, which

adopted PHC as an approach towards the design, development
and implementation of programs focusing on health
development at community level.
Rationale for Adopting Primary Health Care
Magnitude of Health Problems

Inadequate and unequal distribution of health

resources
Increasing cost of medical care

Isolation of health care activities from other

development activities
Definition of Primary Health Care
essential health care made universally accessible to

individuals and families in the community by means

acceptable to them, through their full participation
and at cost that the community can afford at every
stage of development.
Goal:
HEALTH FOR ALL FILIPINOS by the year 2000 AND
PHC Theme:
HEALTH IN THE HANDS OF THE PEOPLE by the year

2020.
An improved state of health and quality of life for all

people attained through SELF RELIANCE.

Key Strategy to Achieve the Goal:
Partnership with and Empowerment of the people – permeate
as the core strategy in the effective provision of essential health
services that are community based, accessible, acceptable, and
sustainable, at a cost, which the community and the
government can afford.
Objectives of Primary Health Care
Improvement in the level of health care of the community
Favorable population growth structure

Reduction in the prevalence of preventable, communicable and

other disease.
Reduction in morbidity and mortality rates especially among

infants and children.

Extension of essential health services with priority given to the

underserved sectors.
Improvement in Basic Sanitation

Development of the capability of the community aimed at self-

reliance.
Maximizing the contribution of the other sectors for the social

and economic development of the community.

Elements of Primary Health Care

1. Education for Health

Is one of the potent methodologies for information
dissemination. It promotes the partnership of both the
family members and health workers in the promotion
of health as well as prevention of illness.

2.Locally Endemic Disease Control

The control of endemic disease focuses on the
prevention of its occurrence to reduce morbidity rate.
Example Malaria Control and Schistosomiasis Control
 3. Expanded Program on Immunization
This program exists to control the occurrence of
preventable illnesses especially of children below 6
years old. Immunizations on poliomyelitis, measles,
tetanus, diphtheria and other preventable disease
are given for free by the government and ongoing
program of the DOH
 4. Maternal and Child Health and Family Planning

The mother and child are the most delicate members

of the community. So the protection of the mother
and child to illness and other risks would ensure
good health for the community. The goal of Family
Planning includes spacing of children and
responsible parenthood.
 5. Environmental Sanitation and Promotion of Safe Water
Supply
Environmental Sanitation is defined as the study of all factors in
the man’s environment, which exercise or may exercise
deleterious effect on his well-being and survival. Water is a
basic need for life and one factor in man’s environment. Water
is necessary for the maintenance of healthy lifestyle. Safe
Water and Sanitation is necessary for basic promotion of
health.
 6. Nutrition and Promotion of Adequate Food Supply
One basic need of the family is food. And if food is properly
prepared then one may be assured healthy family. There are
many food resources found in the communities but because of
faulty preparation and lack of knowledge regarding proper
food planning, Malnutrition is one of the problems that we
have in the country.
 7. Treatment of Communicable Diseases and Common Illness
The diseases spread through direct contact pose a great risk to
those who can be infected. Tuberculosis is one of the
communicable diseases continuously occupies the top ten
causes of death. Most communicable diseases are also
preventable. The Government focuses on the prevention,
control and treatment of these illnesses.
 8. Supply of Essential Drugs
This focuses on the information campaign on the utilization and
acquisition of drugs.
In response to this campaign, the GENERIC ACT of the Philippines
is enacted. It includes the following drugs: Cotrimoxazole,
Paracetamol, Amoxycillin, Oresol, Nifedipine, Rifampicin, INH
(isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
Principles of Primary Health Care
1.4 A’s = Accessibility, Availability, Affordability &
Acceptability, Appropriateness of health services.
The health services should be present where the
supposed recipients are. They should make use of the
available resources within the community, wherein
the focus would be more on health promotion and
prevention of illness.

2.
Community Participation
heart and soul of PHC
 3.People are the center, object and subject of
development.
Thus, the success of any undertaking that aims at serving the people
is dependent on people’s participation at all levels of decision-
making; planning, implementing, monitoring and evaluating. Any
undertaking must also be based on the people’s needs and
problems (PCF, 1990)
Part of the people’s participation is the partnership between the
community and the agencies found in the community; social
mobilization and decentralization.
In general, health work should start from where the people are and
building on what they have. Example: Scheduling of Barangay
Health Workers in the health center
Barriers of Community Involvement

Lack of motivation Attitude

Resistance to change Dependence on the part of community people
Lack of managerial skills
 4. Self-reliance
Through community participation and cohesiveness of people’s
organization they can generate support for health care
through social mobilization, networking and mobilization of
local resources. Leadership and management skills should
be develop among these people. Existence of sustained
health care facilities managed by the people is some of the
major indicators that the community is leading to self
reliance.

 5. Partnership between the community and the

health agencies in the provision of quality of life.
Providing linkages between the government and the
nongovernment organization and people’s organization.
 6. Recognition of interrelationship between the
health and development
Health- Is not merely the absence of disease. Neither is it only a
state of physical and mental well-being. Health being a
social phenomenon recognizes the interplay of political,
socio-cultural and economic factors as its determinant.
Good Health therefore, is manifested by the progressive
improvements in the living conditions and quality of life
enjoyed by the community residents (PCF,
Development- is the quest for an improved quality of life for all.
Development is multidimensional. It has political, social,
cultural, institutional and environmental dimensions
(Gonzales 1994). Therefore, it is measured by the ability of
people to satisfy their basic needs.
 7. Social Mobilization
It enhances people participation or governance,
support system provided by the Government,
networking and developing secondary leaders.

 8. Decentralization
This ensures empowerment and that empowerment
can only be facilitated if the administrative
structure provides local level political structures
with more substantive responsibilities for
development initiators. This also facilities proper
allocation of budgetary resources.
Major Strategies of Primary Health Care
1. Elevating Health to a Comprehensive and Sustained National
Effort.
2. Promoting and Supporting Community Managed Health Care
3. Increasing Efficiencies in the Health Sector
4. Advancing Essential National Health Research

Four Cornerstones/Pillars in Primary Health Care

Active Community Participation
Intra and Inter-sectoral Linkages

Use of Appropriate Technology

Support mechanism made available

 Two Levels of Primary Health Care Workers

1. Barangay Health Workers – trained community

health workers or health auxiliary volunteers
or traditional birth attendants or healers.

2. Intermediate level health workers- include the

Public Health Nurse, Rural Sanitary Inspector
and midwives.
 Traits and Qualities of a Health Worker
1. Efficient
plans with the people, organizes, conducts, directs health
education activities according to the needs of the community
knowledgeable about everything relevant to his practice; has
the necessary skills expected of him
2.Good listener
hears what’s being said and what’s behind the words
always available for the participant to voice out their sentiments
and needs
3. Keen observer
keep an eye on the proceedings, process and participants’
behavior
4. Systematic
knows how to put in sequence or logical order

the parts of the session

5. Creative/Resourceful
uses available resources

6. Analytical/Critical thinker
decides on what has been analyzed

7. Tactful
brings about issues in smooth subtle manner

does not embarrass but gives constructive

criticisms
8. Knowledgeable
able to impart relevant, updated and sufficient input
9. Open
invitesideas, suggestions, criticisms
involves people in decision making

accepts need for joint planning and decision relative to health

care in a particular situation; not resistant to change

10.Sense of humor
knows how to place a touch of humor to keep audience alive
11. Change agent
involvesparticipants actively in assuming the responsibility for
his own learning
12. Coordinator
brings into consonance of harmony the

community’s health care activities

13. Objective
unbiased and fair in decision making

14. Flexible
able to cope with different situations
 Functions of a Health Worker
Functions of a Health Worker
1. Community Health Service Provider
Carries out health services contributing to the promotion of
health, prevention of illness, early treatment of illness and
rehabilitation.
appraises health needs and hazards (existing or potential)
2. Facilitator
helps plan a comprehensive health program with the people
continuing guidance and supervisory assistance
functions of a Health Worker.
3. Health Counselor
provides health counseling including emotional support to
individuals, family, group and community
4. Co-researcher
Provides the community with stimulation necessary for a wider
or more complex study or problems.
Enforce community to do prompt and intelligent reporting of
epidemiologic investigation of disease.
suggest areas hat need research (by creating dissatisfaction)
participate in planning for the study in formulating procedures
Assist in the collection of data
Helps interpret findings collectively
Act on the result of the research
5. Member of a Team
in operating within the team, one must be willing to
listen as well as to contribute, to teach as well as to
learn, to lead as well as to follow, to share as well as
to work under it
helps make multiple services which the family receives
in the course of health care, coordinated, continuous
and comprehensive as possible
consults with and refers to appropriate personnel for
any other community services
6. Health Educator
Health education is an accepted activity at all levels of public
works. A health educator is the one who improves the health of
the people by employing various methods of scientific
procedures to stimulate, arouse and guide people to healthful
ways of living. She takes into consideration these aspects of
health education:
information – provision of knowledge
education – change in knowledge, attitude and skills
communication – exchange of information
Primary (heath Secondary (early Tertiary (limitation of
promotion and specific diagnosis and disability and
protection) treatment) rehabilitation)

•Dietary teaching during •HIV testing •Teaching new clients

pregnancy •Screening for cervical with diabetes how to
•Immunizations CA administer insulin
•Education or counseling •Dental examinations •Exercise therapy after
regarding smoking, •Diabetes screening for stroke
dental care or nutrition family at risk •Skin care for incontinent
•Adequate housing •Vision screening of first- patients
•Mother’s class on grade school •Mental health
breastfeeding •Mass sputum counseling or referral for
•Education for drug examination in a low- family in crisis
abuse prevention for income neighborhood •Dietary instructions and
high school students •Hearing tests at a center monitoring for family
for the elderly with overweight
members
•Primary (heath Secondary (early Tertiary (limitation of
promotion diagnosis and disability and
ancommunities treatment) rehabilitation)
•VDRL scred specific
protection)
•Flouride water •Organized screening •Group counseling for
supplementation programs for ening for grade school children
•Environmental marriage license with asthma
sanitation applicants in a city •Exercise program for
•Removal of diabetics at a center for
environmental hazards the elderly
•Alcoholics Anonymous
and other self-help
groups
•Mental health services
for military veterans
 Legal Basis: RA 11223
 an Act instituting Universal Health
Care for all Filipinos, prescribing
reforms in the health care system, and
appropriating funds therefor.
 Universal Health Care Act

automatically enrolls all Filipino citizens

in the National Health Insurance Program
and prescribes complementary reforms in
the health system.
 UHC's Background and Rationale
Universal Health Care is an approach that seeks to
improve, streamline, and scale up the reform
strategies in HSRA and Fl in order to address
inequities in health outcomes by ensuring that all
Filipinos, especially those belonging to the lowest
two income quintiles, have equitable access to
quality health care.
 UHC's Objective
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.
 UHC’s Three Thrusts

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
3) Attainment of health-related Millennium Development
Goals (MDGs).
Milestone in Health Care Delivery System
RA 1082 – RHU Act

There shall be created rural health units of two classes: one of category one or senior rural health
unit consisting of one municipal health officer as head of the unit, one public health nurse, one mid-
wife and one sanitary inspector; another of category two or junior rural health unit consisting of one
physician or public health nurse as head of the unit and one midwife or sanitary inspector. Each
municipality or group of municipal districts having a population of not less than five thousand shall
have a rural health unit of category one: Provided, however, that a municipality with more than
thirty-five thousand inhabitants shall have an additional rural health unit of category two. If the
public service so demands, the Director of Health, upon approval of the Secretary of the Department
of Health, can regroup neighboring barrios and assign to each group a rural health unit of whatever
category the circumstances warrant.cralaw
 RA 1891 – Strengthen Health Services
> An Act strengthening health and dental services in the rural
areas, and providing funds therefor".
> There shall be created rural health units of eight different
categories or staff of personnel corresponding to eight
population groups of municipalities to be served based on a
more equitable and scientific distribution on the ratio of
personnel to population:
Category I, consisting of one midwife and one sanitary
inspector, to be allotted to a municipality of Group I with
population up to Category II, consisting of one public health
nurse and one midwife or one sanitary inspector, to be
allotted to a municipality of Group II with population from
two thousand to five thousandtwo thousand.
Category III, consisting of one municipal health officer, as head
of the unit, one public health nurse, one midwife and one
sanitary inspector, to be allotted to a municipality of Group III
with population from five thousand to ten thousand.
Category IV, consisting of one municipal health officer, as head
of the unit, one public health nurse, two midwives and one
sanitary inspector, to be allotted to a municipality of Group IV
with population from ten thousand to twenty thousand.
Category V, consisting of one municipal health officer, a head of
the unit, two public health nurses, two midwives and one
sanitary inspector, to be allotted to a municipality of Group V
with population from twenty thousand to thirty thousand.
Category VI, consisting of two municipal health officers, two
public health nurses, two midwives and two sanitary
inspectors, to be allotted to a municipality of Group VI with
population from thirty thousand to forty thousand
 Category VII, consisting of two municipal health
officers, two public health nurses, three midwives and
three sanitary inspectors, to be allotted to a
municipality of Group VII with population from forty
thousand to fifty thousand;
Category VIII, consisting of two municipal health
officers, four public health nurses, four midwives and
three sanitary inspectors, to be allotted to a
municipality of Group VIII with population from fifty
thousand and over.
 PD 568 – Restructuring HCDS
Role of Public Health midwives has been expanded after the
implementation of the Restructed Health Care Delivery System
(RHCDS)
Deployment of midwives to improve rural situation (1 PHMid =
5,000 pop.; 1 PHNurse = 10,000 pop; 1 RHPhysician = 20,000
pop)
 RA 7160 – LGU Code
otherwise known as the Local Government Code was enacted
into law, transferring control and responsibility of delivering
basic services to the hands of local government units (LGU).
It aimed to enhance provision of services in the grass roots
level as well as improve the efficiency in resource allocation.