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Philippine Health Care Delivery System

NCM 104

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Learning Outcome

  • Engage in advocacy activities to influence health and social care service policies and access to services.

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Contents

A. The Department of Health

  1. Vision/Mission/ Objectives/Strategic Goals
  2. National Objectives for Health
  3. The Millennium Development Goals.
    1. Eradicate extreme poverty and hunger.
    2. Achieve universal primary education
    3. Promote gender equality and empowerment of women
    4. Reduce child mortality.
    5. Improve maternal health
    6. Combat HIV/AIDS, malaria and other diseases
    7. Ensure environmental sustainability
    8. Develop a global partnership for development

4. Levels of Health Care Facilities

5. Health Devolution in the Philippines

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Vision

  •  Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040

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Mission

  •  To lead the country in the development of a productive, resilient, equitable and people-centered health system

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The Department of Health (DOH) holds the over-all technical authority on health as it is a national health policymaker and regulatory institution.�

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DOH Three Major Roles in the Health Sector

  • Leadership in Health
  • Enabler and Capacity Builder
  • Administrator of Specific Services
    • 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.

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While Pursuing Its Vision, The DOH Adheres to the Highest Values of Work, Which are

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National Objectives for Health Philippines 2017-2022�

  •  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
    • Governance
    • Performance Accountability.

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This ultimately leads to the three major goals that the Philippine Health Agenda aspires for:

        • Better health outcomes with no major disparity among population groups;
        • Financial risk protection for all especially the poor, marginalized and vulnerable; and
        • A responsive health system which makes Filipinos feel respected, valued and empowered.

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Summary of Selected Health Outcomes - Philippines

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Ten Leading Causes of Mortality – Philippines, 2016

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Ten Leading Causes of Morbidity – Philippines, 2016

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The Millennium Development Goals

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The Millennium Development Goals

  • At the start of the century, all 189 United Nations Member States unanimously agreed to forge a commitment via the Millennium Declaration to assist the poorest to achieve better living standards by the year 2015.

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The Millennium Development Goals

  • The United Nation’s member states Millennium Development Goals (MDGs) for 2015 include reducing maternal and neonatal mortality rates, infectious diseases such as HIV/AIDS and tuberculosis. Significant progress has been made and the member states particularly developing countries made substantial headway so far in attaining these goals.

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In the Philippines, one of the main reasons for the country’s relentless pursuit of ensuring access to quality health care services through its Universal Health Care platform is the attainment of the targets that the country has committed in the Millennium Development Goals (MDGs).

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The Department of Health as the leader in health, has initiated the implementation of health reforms for the rapid reduction of maternal and neonatal mortality. �

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MDG1 – Eradicate Extreme Poverty and Hunger

  • Millions continue to live in hunger and poverty, lacking access to basic services
  • Despite remarkable progress, about 800 million people continue to live in absolute poverty and suffer from hunger. More than 160 million children below 5-years have inadequate height for their age because of insufficient food.

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MDG2 – Achieve Universal Primary Education

  • In 2015, 57 million children of primary school age do not attend school.
  • Compared to children in the richest households, those in the poorest households are four times more likely to be out of school. Under-five mortality rates are nearly twice as high for children in the poorest households compared to the wealthiest households.

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MDG 3: Promote gender equality and empower women

  • Gender inequality persists.
  • Women in many parts of the world continue to face discrimination in access to economic assets, work, and participation in public and private decision-making.
  • They are also more likely to live in poverty compared to men.

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MDG 3: Promote gender equality and empower women

  • In 85 percent of the 92 nations with data on the rate of unemployment based on the level of education between 2012 and 2013, women with tertiary education tend to have higher rates of unemployment compared to men with similar levels of education.

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MDG 4: Reduce child mortality

  • About 16,000 children die each day before they reach five years of age, mostly due to preventable causes.
  • In the developing nations, children from 20 percent of the poorest households are more than twice as likely to be stunted as those from 20 percent of the wealthiest.

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MDG 5: Improve Maternal Health

  • The maternal mortality ratio in developing nations is 14 times higher than in the developed nations.
  • J50 percent of pregnant women in developing countries can receive the recommended minimum of 4 antenatal care visits
  • In rural areas, 44 percent of births are done in the absence of skilled health personnel, compared with 13 percent in urban areas.

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MDG 6: Combat HIV/AIDS, Malaria and Other Diseases

  • An estimated 36 percent of the 31.5 million people living with HIV in developing nations were said to be receiving  antiretroviral therapy (ART) in 2013.

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MDG 7: Ensure Environmental Sustainability

  • Close to 5.2 million hectares of forest cover were lost in 2010.
  • Climate change and environmental degradation undercut progress achieved

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MDG 7: Ensure Environmental Sustainability

Global emissions of carbon dioxide have increased by more than 50 percent since 1990.

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MDG 7: Ensure Environmental Sustainability

  • The surge in greenhouse gas emissions has impacted climate change with regard to weather extremes, altered ecosystems, and risks to society, which remain urgent and critical challenges for the universal community.

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The overexploitation of marine fish stocks resulted in the decline in the percentage of stocks within the safe biological limits – from 90 to 71 percent between 1974 and 2011. Generally, all species are declining in numbers and distribution, increasing the risk of extinction.�

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Water shortage affects 40 percent of the global population and is projected to increase.

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In 2015, an estimated 2.4 billion people (One in three) use unimproved sanitation facilities, including 946 million people still practicing open defecation.�

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About 84 percent of the rural population has access to improved drinking water sources compared to 96 percent of the urban dwellers.�

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MDG 8: Develop a Global Partnership for Development

  • Conflict remains the greatest threat to human development.
  • By 2015, conflicts had forced nearly 60 million people to leave their homes – the highest number recorded since the Second World War

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MDG 8: Develop a Global Partnership for Development

  • Every day, about 42,000 people are forcibly displaced and compelled to seek protection due to conflicts, which is nearly 4 times the number in 2010 (11,000).

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MDG 8: Develop a Global Partnership for Development

  • 50 percent of the global refugee population is made up of children, which has constituted to the increase in number of out-of-school children from 30 percent to 36 percent between 1999 and 2012.

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In September 2015, the United Nations Member States adopted a new global plan of action entitled, “Transforming Our World: The 2030 Agenda for Sustainable Development.”  �

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The 2030 Agenda, its 17 Goals and 169 targets are a universal set of goals and targets that aim to stimulate people-centered and planet-sensitive change.�

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The 193 member states of the United Nations (UN) gathered to affirm commitments towards ending all forms of poverty, fighting inequalities and increasing country’s productive capacity, increasing social inclusion and curbing climate change and protecting the environment while ensuring that no one is left behind over the next fifteen years.�

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Difference Between SDGs and MDGs

SDGs benefit from the valuable lessons learned from MDGs.

These also carry forward the unfinished agenda of MDGs for continuity and sustain the momentum generated while addressing the additional challenges of inclusiveness, equity, and urbanization and further strengthening global partnership by including CSOs and private sector.

They reflect continuity and consolidation of MDGs while making these more

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Health Devolution in the Philippines

  • In 1991 the Philippine Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991.
  • The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units.

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Health Devolution in the Philippines

  • 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.

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Local Government Code of 1991 Republic Act No. 7160 has changed the way basic government health services are delivered at the local level.

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From a highly centralized system of health service delivery with the Department of Health (DOH) as the sole provider, the Code mandated the devolution to local government units (LGUs) of many of the functions previously discharged by DOH. �

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As a result of health devolution, LGUs have taken on the great responsibility in the delivery of basic services and in the operation of facilities in areas that include primary health care and hospital care/services. �

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Implications of Health Devolution: Issues and Challenges

The fact remained that many LGUs were not ready for the devolution in terms of both financial and human resource.

Fiscal capacity of LGUs and managerial capability of local chief executives (LCEs) were not considered prior to devolution.

There was no capacity building for local officials and health personnel before the devolution (Grundy et al. 2003).

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Implications of Health Devolution: Issues and Challenges

There was no sufficient preparation that would enable all those affected by health devolution to cope with the tremendous changes it brought (DOH 1997).

Local Health Board (LHB), were conducted in 1994

A strategic plan for the introduction of devolution (i.e., prior to health devolution) was lacking (Grundy et al. 2003).

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The issues and challenges of health devolution can be summarized into three broad topics, namely:

Financial Issue

Health personnel

Organization/Structural Change

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Financial Issue

  • Mismatch between the internal revenue allotment (IRA) and the cost of devolved functions
  • Many provinces and smaller municipalities had insufficient funds to pay the salaries of the national workers devolved to them (Perez 1998a and Perez 1998b), not to mention the cost of implementing the Magna Carta for public health workers as mandated in Republic Act 7305 of 1992.

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Health Personnel

      • Some LGUs refused to accept the devolved health workers for varying reasons. In response, the Oversight Committee for the Code held hearings in all regions to address the misunderstanding among local governments, devolved workers, and concerned national government agencies.

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Health Personnel

      • In Metro Manila, some municipal mayors were not willing to absorb the cost of devolved health personnel because they believed that it was estimated based on questionable plantilla while some other municipal mayors thought that having too many highly paid workers, particularly doctors, would hinder their plans for cityhood and still some others thought that the salaries of devolved workers would be higher than that of the existing city health officers.

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Organization/Structural Change

  • The Code requires the creation and composition of a Local Health Board (LHB) in every province, city, or municipality with the local chief executives (i.e., governor in the case of provinces and mayor in the case of cities and municipalities) as chair and the local health officers as vice-chair.

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Local Health Board

  • It is tasked to prepare the annual budget for health, act as an advisory committee on health matters, and create committees that shall guide in personnel selection and promotion, bids and awards, and budget review, among others (Book I, Title Five, Section 102).

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Health devolution affected the Delivery Health System to a large extent because it disintegrated the chain of health care delivery system when the administration of health facilities was transferred from the province to different jurisdictions

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Primary

  • Barangay Health Stations (BHS) are managed by barangay and municipal/city governments while rural health units (RHUs) and city health centers are managed by municipal and city governments, respectively

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Secondary

  • Municipal or District Hospitals/Provincial Hospitals are managed by provincial government

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Tertiary

  • Provincial Hospitals are managed by provincial hospitals and regional hospitals (also known as retained hospitals) are managed by the DOH

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Levels of Health Care Facilities�There are 3 different levels of health care system

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Primary Level of Care

Devolved to cities and municipalities

Usually the first contact between the community members and other levels of health facility.

Center physicians, public health nurse, rural health midwives, barangay Health workers, traditional healers.

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Secondary Level of Care

  • Given by physicians with basic health training.
  • Usually given in health facilities either private owned or government operated.
  • Infirmaries, municipal, district hospital, out-patient departments.
  • Rendered by specialists in health facilities.

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Tertiary Level of Care

  • Referral system for the secondary care facilities.
  • Provided complicated cases and intensive care.
  • Medical centers, regional and provincial hospitals and specialized hospitals.

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END