THE HEALTH CARE DELIVERY SYSTEM

THE TOTALITY OF ALL POLICIES, FACILITIES, 2. Zero hunger

EQUIPMENT, PRODUCTS, HUMAN RESOURCES, 3. Good health and well-being
AND SERVICES THAT ADDRESS THE HEALTH 4. Quality education
NEEDS PROBLEMS, AND CONCERNS OF THE 5. Gender equality
PEOPLE. IT IS LARGE, COMPLEX, MULTI-LEVEL, 6. Clean water and sanitation
AND MULTI-DISCIPLINARY. 7. Affordable and clean energy
8. Decent work and economic growth
Health Sectors 9. Industry, innovation, infrastructure
● Government Sectors 10. Reduced inequality
● Non Government Sectors 11. Sustainable cities and communities
● Private Sectors 12. Responsible production and consumption
13. Climate action
Factors that influence the health care 14. Life below water
delivery system: 15. Life on land
● Health care reforms 16. Peace and justice strong institutions
● Demographics 17. Partnerships to achieve the goal
● Globalization
● Poverty and growing disparities B. Philippine Department of Health
● Social Disintegration
Vision:( To be the leader of health for all in the
Global and Country Health Trend Philippines)Filipinos are among the healthiest people
❑ Shifts in demographic and epidemiological in Southeast Asia by 2022, and Asia by 2040.
trends in diseases.
Mission:( Guarantee equitable, sustainable, and
❑ New technologies of health care,
quality health for all Filipinos, especially the poor, and
communication, and information.
to lead the quest for excellence in health.) To lead the
❑ Existing and emerging environmental
country in the development of a productive, resilient,
hazard
equitable, and people-centered health system
❑ Health reforms
DOH Core Values
❑

A. World Health Organization

1. Millennium Developmental Goal ( MDG ) 1. Integrity
Target – Reduce global poverty and hunger 2. Excellence
2. Sustainable Development Goals (SDG ) 3. Compassion and respect for human dignity
A collection of 17 global goals designed to be a 4. Commitment
"blueprint to achieve a better and more sustainable 5. Professionalism
future for all". The SDGs, set in 2015 by the United 6. Teamwork
Nations General Assembly and intended to be 7. Stewardship of the health of the people.
achieved by the year 2030.
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.
1. Eradicate extreme poverty and hunger ▣ With a shift to a parliamentary form of
2. Achieve universal primary education government, the Department of Health was
3. Promote gender equality and empower women transformed into the Ministry of Health on
4. Reduce child mortality June 2, 1978.
5. Improve maternal health ▣ On April 13, 1987, the Department of
6. Combat HIV/AIDS, Malaria, and other diseases Health was created by the previous Ministry
7. Ensure environmental sustainability of Health.
8. Global partnership for development ▣ 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
1. No poverty 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 the 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

 Definition of Primary Health Care
● Essential health care is made universally
accessible to individuals and families in the
community by means acceptable to them,
through their full participation and at a 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
● The favorable population growth structure
● Reduction in the prevalence of preventable,
communicable, and other diseases.
● 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.
C. Primary Health Care ● Maximizing the contribution of the other
Overview sectors for the social and economic
● May 1977 - 30th World Health Assembly development of the community.
decided that the main health target of the ● Elements of Primary Health Care
government and WHO is the attainment of a 1. Education for Health
level of health that would permit them to lead Is one of the potent methodologies for information
a socially and economically productive life by dissemination. It promotes the partnership of both
the year 2000. the family members and health workers in the
● September 6-12, 1978 – First International promotion of health as well as prevention of illness.
Conference on PHC in Alma Ata, Russia 2. Locally Endemic Disease Control
(USSR) The Alma Ata Declaration stated that The control of endemic disease focuses on the
PHC was the key to attain the “health for all” prevention of its occurrence to reduce the
goal morbidity rate. Example Malaria Control and
● October 19, 1979 – Letter of Instruction Schistosomiasis Control
(LOI) 949, the legal basis of PHC was signed 3. Expanded Program on Immunization
by Pres. Ferdinand E. Marcos, which This program exists to control the occurrence of
adopted PHC as an approach towards the preventable illnesses especially of children below
design, development, and implementation of 6 years old. Immunizations on poliomyelitis,
programs focusing on health development at measles, tetanus, diphtheria and other
the community level. preventable disease are given for free by the
The rationale for Adopting Primary Health Care government and ongoing program of the DOH
● MagnitudeThe magnitude of Health Problems
● Inadequate and unequal distribution of health 4. Maternal and Child Health and Family Planning
resources The mother and child are the most delicate
● IncreasingThe increasing cost of medical care members of the community. So the protection of
● Isolation of health care activities from other the mother and child to illness and other risks
development activities would ensure good health for the community. The
goal of Family Planning includes spacing of
 children and responsible parenthood. where the people are and building on what
5. Environmental Sanitation and Promotion of they have. Example: Scheduling of Barangay
Safe Water Supply Health Workers in the health center
Environmental Sanitation is defined as the study
of all factors in the man’s environment, which Barriers of Community Involvement
exercise or may exercise deleterious effect on his ● Lack of motivation
well-being and survival. Water is a basic need for ● Attitude
life and one factor in man’s environment. Water is ● Resistance to change
necessary for the maintenance of healthy lifestyle. ● Dependence on the part of community
Safe Water and Sanitation is necessary for basic people
promotion of health. ● Lack of managerial skills
6. Nutrition and Promotion of Adequate Food 4. Self-reliance
Supply Through community participation and
One basic need of the family is food. And if food is cohesiveness of people’s organizations, they
properly prepared then one may be assured can generate support for health care through
healthy family. There are many food resources social mobilization, networking, and
found in the communities but because of faulty mobilization of local resources. Leadership and
preparation and lack of knowledge regarding management skills should be developed
proper food planning, Malnutrition is one of the among these people. The existence of
problems that we have in the country. sustained health care facilities managed by the
people is one of the major indicators that the
7. Treatment of Communicable Diseases and
community is leading to self-reliance.
Common Illness
5. Partnership between the community and the
The diseases spread through direct contact pose
health agencies in the provision of quality of life.
a great risk to those who can be infected.
Providing linkages between the government
Tuberculosis is one of the communicable
and the non-government organization and
diseases continuously occupies the top ten
people’s organization.
causes of death. Most communicable diseases
6. Recognition of interrelationship between the
are also preventable. The Government focuses on
health and development
the prevention, control and treatment of these
● Health- Is not merely the absence of
illnesses.
disease. Neither is it only a state of physical
8. Supply of Essential Drugs
and mental well-being. Health being a social
● This focuses on the information campaign on
phenomenon recognizes the interplay of
the utilization and acquisition of drugs.
political, socio-cultural and economic factors
● In response to this campaign, the GENERIC
as its determinant. Good Health therefore, is
ACT of the Philippines is enacted. It includes
manifested by the progressive improvements
the following drugs: Cotrimoxazole,
in the living conditions and quality of life
Paracetamol, Amoxycillin, Oresol, Nifedipine,
enjoyed by the community residents (PCF,
Rifampicin, INH (isoniazid) and Pyrazinamide,
● Development- is the quest for an improved
Ethambutol, Streptomycin,
quality of life for all. Development is
Albendazole,Quinine
multidimensional. It has political, social,
cultural, institutional and environmental
Principles of Primary Health Care dimensions (Gonzales 1994). Therefore, it is
1. 4 A’s = Accessibility, Availability, Affordability measured by the ability of people to satisfy
& Acceptability, Appropriateness of health their basic needs.
services. 7. Social Mobilization
The health services should be present where the It enhances people participation or governance,
supposed recipients are. They should make use of support system provided by the
the available resources within the community, Government, networking and developing
wherein the focus would be more on health secondary leaders.
promotion and prevention of illness. 8. Decentralization
2. Community Participation This ensures empowerment and that
heart and soul of PHC empowerment can only be facilitated if the
3.People are the center, object and subject of administrative structure provides local level
development. political structures with more substantive
● Thus, the success of any undertaking that responsibilities for development initiators. This
aims at serving the people is dependent on also facilities proper allocation of budgetary
people’s participation at all levels of resources.
decision-making; planning, implementing, Major Strategies of Primary Health Care
monitoring and evaluating. Any undertaking 1. Elevating Health to a Comprehensive and
must also be based on the people’s needs Sustained National Effort.
and problems (PCF, 1990) 2. Promoting and Supporting Community Managed
● Part of the people’s participation is the Health Care
partnership between the community and the 3. Increasing Efficiencies in the Health Sector
agencies found in the community; social 4. Advancing Essential National Health Research
mobilization and decentralization.
● In general, health work should start from
Four Cornerstones/Pillars in Primary Functions of a Health Worker
Health Care 1. Community Health Service Provider
● Active Community Participation ● Carries out health services contributing to the
● Intra and Inter-sectoral Linkages promotion of health, prevention of illness,
● Use of Appropriate Technology early treatment of illness and rehabilitation.
● Support mechanism made available ● appraises health needs and hazards
(existing or potential)
Two Levels of Primary Health Care 2. Facilitator
● helps plan a comprehensive health program
Workers with the people
1. Barangay Health Workers – trained community ● continuing guidance and supervisory
health workers or health auxiliary assistance
volunteers or traditional birth attendants or ● functions of a Health Worker.
healers.
2. Intermediate level health workers - include the 3. Health Counselor
Public Health Nurse, Rural Sanitary ● provides health counseling including
Inspector and midwives. emotional support to individuals, family,
group and community
Traits and Qualities of a Health Worker 4. Co-researcher
1. Efficient ● Provides the community with stimulation
● plans with the people, organizes, conducts, necessary for a wider or more complex study
directs health education activities according or problems.
to the needs of the community ● Enforce community to do prompt and
● knowledgeable about everything relevant to intelligent reporting of epidemiologic
his practice; has the necessary skills investigation of disease.
expected of him ● suggest areas hat need research (by
2.Good listener creating dissatisfaction)
● hears what’s being said and what’s behind ● participate in planning for the study in
the words formulating procedures
● always available for the participant to voice ● Assist in the collection of data
out their sentiments and needs ● Helps interpret findings collectively
3. Keen observer ● Act on the result of the research
● keep an eye on the proceedings, process
and participants’ behavior 5. Member of a Team
4. Systematic ● in operating within the team, one must be
● knows how to put in sequence or logical willing to listen as well as to contribute, to
order the parts of the session teach as well as to learn, to lead as well as to
5. Creative/Resourceful follow, to share as well as to work under it
● uses available resources ● helps make multiple services which the
6. Analytical/Critical thinker family receives in the course of health care,
● decides on what has been analyzed coordinated, continuous and comprehensive
7. Tactful as possible
● brings about issues in smooth subtle manner ● consults with and refers to appropriate
● does not embarrass but gives constructive personnel for any other community services
criticisms
8. Knowledgeable 6. Health Educator
● able to impart relevant, updated and ● Health education is an accepted activity at all
sufficient input levels of public works. A health educator is
9. Open the one who improves the health of the
● invites ideas, suggestions, criticisms people by employing various methods of
● involves people in decision making scientific procedures to stimulate, arouse and
● accepts the need for joint planning and guide people to healthful ways of living. She
decision relative to health care in a particular takes into consideration these aspects of
situation; not resistant to change health education:
10. Sense of humor ● information – provision of knowledge
● knows how to place a touch of humor to keep ● education – change in knowledge, attitude
audience alive and skills
11. Change agent ● communication – exchange of information
● involves participants actively in assuming the D. Levels of Prevention
responsibility for their 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
 Levels of Prevention seeks to improve, streamline, and scale up
the reform strategies in HSRA and Fl in order
to address inequities in health outcomes by
Primary (heath Secondary Tertiary ensuring that all Filipinos, especially those
promotion and (early diagnosis (limitation of belonging to the lowest two income quintiles,
specific and treatment) disability and have equitable access to quality health care.
protection) rehabilitation)
UHC's Objective
•Dietary teaching •HIV testing •Teaching new ● to ensure that every Filipino shall receive
during •Screening for clients with affordable and quality health benefits.This
pregnancy cervical CA diabetes how to involves providing adequate resources –
•Immunizations •Dental administer insulin health human resources, health facilities, and
•Education or examinations •Exercise therapy health financing.
counseling •Diabetes after stroke UHC’s Three Thrusts
regarding screening for •Skin care for 1. Financial risk protection through expansion in
smoking, dental family at risk incontinent enrollment and benefit delivery of the
care or nutrition •Vision screening patients National Health Insurance Program (NHIP)
•Adequate of first-grade •Mental health 2. Improved access to quality hospitals and
housing school counseling or health care facilities
•Mother’s class •Mass sputum referral for family 3. Attainment of health-related Millennium
on breastfeeding examination in a in crisis Development Goals (MDGs).
•Education for low-income •Dietary
drug abuse neighborhood instructions and Milestone in Health Care Delivery
prevention for •Hearing tests at monitoring for System
high school a center for the family with ● RA 1082 – RHU Act
students elderly overweight There shall be created rural health units of
members 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
•Primary (heath Secondary Tertiary (limitation inspector; another of category two or junior
promotion (early of disability and rural health unit consisting of one physician
ancommunities diagnosis rehabilitation) or public health nurse as head of the unit and
•VDRL scred and one midwife or sanitary inspector. Each
specific treatment) municipality or group of municipal districts
protection) having a population of not less than five
thousand shall have a rural health unit of
•Flouride water •Organized •Group counseling category one: Provided, however, that a
supplementation screening for grade school municipality with more than thirty-five
•Environmental programs for children with asthma thousand inhabitants shall have an additional
sanitation ening for •Exercise program rural health unit of category two. If the public
•Removal of marriage for diabetics at a service so demands, the Director of Health,
environmental license center for the elderly upon approval of the Secretary of the
hazards applicants in a •Alcoholics Department of Health, can regroup
city Anonymous and neighboring barrios and assign to each group
other self-help a rural health unit of whatever category the
groups circumstances warrant.cralaw
•Mental health
services for military ● RA 1891 – Strengthen Health Services
veterans ❖ An Act strengthening health and dental
services in the rural areas, and providing
funds therefor".
E. Universal Health Care ❖ There shall be created rural health units of
eight different categories or staff of personnel
Legal Basis: RA 11223 corresponding to eight population groups of
● an Act instituting Universal Health Care for municipalities to be served based on a more
all Filipinos, prescribing reforms in the health equitable and scientific distribution on the
care system, and appropriating funds ratio of personnel to population:
therefor. ● Category I, consisting of one midwife and
● Universal Health Care Act one sanitary inspector, to be allotted to a
● automatically enrolls all Filipino citizens in municipality of Group I with a population up
the National Health Insurance Program and to
prescribes complementary reforms in the ● Category II, consisting of one public health
health system. nurse and one midwife or one sanitary
inspector, to be allotted to a municipality of
UHC's Background and Rationale Group II with population from two thousand
● Universal Health Care is an approach that 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.