II.

WHO BUILDING BLOCKS OF HEALTH SYSTEM

A. Governance

 Devolution
o Act by which the National Government confers power and authority upon various local
government units (LGUs) to perform specific function and responsibilities.

 RA 7160 - “Local Government Code of 1991”

o Legal basis of devolution.
o It devolved the following basic service.
 Agriculture, Forest management, social welfare, Brgy. Level Roads, HEALTH
SERVICES.

B. Health Service Delivery

 Key Elements in Health Service Delivery:

o Organizing health service as a network of primary care backed up by hospitals and
specialized care.
o Providing package of health benefits with clinical and public health service.
o Ensuring access and quality of service.
o Holding providers accountable for access and quality and ensuring consumer voice.
 Forms of Health Service Delivery:
1. Public Sector
 Financed through taxes
 Budgeting system is done at the local and national level
 Health care service is “free” at point of care

2. Public Health
a. LGUs - direct delivery of public health service.
b. DOH
 Provides technical assistance
 Capacity building
 Advisory services for disease prevention and control
 Provides free medicines and vaccines

3) Private Sector
 Profit and non-profit health providers
 Usually market driven
 Service are not free
 Out of pocket scheme
 Insurances
 External funding

 Classification of Health Facilities:

o According to ownership
 Government
 Private

o According to Scope of Service

 General Facilities / Hospitals
 Specialty Center / Hospitals

o According to Functional Capacity

NEW CLASSIFICATION

HOSPITALS OTHER HEALTH FACILITIES

GENERAL A. Primary Care Facility

 Level 1 B. Custodial Care Facility
 Level 2 C. Diagnostic/Therapeutic Facility
 Level 3 (Teacher/Training)

SPECIALTY D. Specialized Out-Patient Facility

 C. Human Resources

 Key Elements in Human Resources for Health:

o Achieving sufficient numbers of the right mix of staff
o Ensuring system wide deployment and distribution
o Establishing job related norms and enabling work environment
o Establishing payments system that produce the right kind of incentives
 Health Providers in the Philippines:
o There are least 22 categories of health workers trained in the Philippines.
 Top four categories of health professionals working in health institutions are
nurses (90 308), doctors (40 775), midwives (43 044), and medical technologists
(13 413).
o Through some categories do not correspond to international classification.

 Trends in Health Personnel:

o Largest category of health workers in the Philippines: Nurses and Midwives.
o There is an underproduction in the other categories, such as doctors and dentists.

 Health Workforce Distribution:

o More hospital-based doctors, nurses, PTs, and OTs are in the private sector than in
Government.
 NCR, Regions III and IV-A have a higher proportion of government health workers
than other regions in PH.

 Career Choices (MDs)

o Government-based positions – not attractive among newly trained MDs -Isolation from other
colleagues
o Perceived lack of incentives
o DOLE
 Specialists - majority
 Generalist - minor
More than half are clustered in Metro Manila
 D. Medicine and Technologies

 Pharmaceuticals reach consumers via a supply-driven distribution scheme

 Drugstores – majority of the population avail their medicine
 Hospitals
 Others: Monopolistic pricing exists in hospital drug sales, especially in private hospitals where outside
purchases are discouraged

Constraints in Accessing Essential Drugs

1. Limited availability - lack of supply

2. Irrational use - the medicine given is not correct, so the stock of essential drugs is depleted
3. High costs

Medical Technologies and Devices

 FDA Center for Device Regulation Radiation Health & Research

 Develops plans, policies, programs, and strategies for regulating health and health-related devices and
technology

 Distribution of Medical Devices

o General radiography represents the most basic equipment across the country
o 2016, the diagnostic imaging equipment licensed by the DOH (public/private) consisted of
4733 radiography (X-ray) machines, 429 computed tomography (CT) machines, 149
mammography machines, and 78 magnetic resonance imaging (MRI) units.
o A larger proportion of the diagnostic imaging equipment is owned by hospitals – specifically
55% for X-rays, 82% for CT machines, 93% for mammography, and 87% for MRIs.
o 46 X-ray and 4.2 CT machines per 1 million population
o 0.8 MRI units per 1 million population.
Density of diagnostic imaging equipment (per million population), 2012–2016

 Rise in generic medicine retailers has provided

o competition to the large drugstore generic retailers located in high-density, low-income
neighborhoods in cities like Metro Manila, sell high-volume over-the-counter medicines at
lower costs
-Dr. Alfredo Bengzon

E. Health Financing

Key Elements in Health Financing

 Raising sufficient funds for health
 Pooling financial resources across population groups and sharing financial risks
 Using funds for health efficiently and equitably

Health Financing in the Philippines

 Low public share for health spending
 Has a high proportion of out-of-pocket spending

 Currently fragmented and inequitable

 PhilHealth cannot yet be considered a strategic purchaser of services because it accounts for a small
share of total health expenditure (THE) while out-of-pocket (OOP) spending is higher (2018)

3 Major Groups of Payers of Healthcare in the Philippines

1. Government
2. Social Health Insurance
3. Private Sources
  RA 7875
o National Health Insurance Act of 1995
o An act instituting national health insurance program and establishing the Philippine Health
Insurance Corporation

 Republic Act No. 10606

o amended Republic Act No. 7875, provides for mandatory coverage of all citizens in
accordance with the principles of universality and compulsory coverage

 Philippine Health Insurance Corporation (PhilHealth)

o Employed Sector Program
o Compulsory coverage of all employees in government and the private sector
o Individually paying program
o Voluntary coverage of the self-employed and others not covered by the rest of the program
o Sponsored Program
o Covers the “poorest of the poor” segment of the population
o Overseas Filipino Worker (OFW)

Key Elements in Health Information

 Provide timely and quality evidence to inform policy and development and planning, health advocacy
and education
 Make information accessible to all stakeholders
 Maximize the use of information technology for better health service

Health Information in the Philippines

 National and local health information systems are poorly integrated and are weakly governed.
 Lack of IT governance structures

National Telehealth Service Program (NTSP)

 Aims to improve communication capabilities and provide better access to up-to-date information,
consultations with clinical specialists, and other forms of support for health professional remote
communities or those providing health care to margin

eMedicine
 Telereferrals
 RxBox – A biomedical device designed to provide better access to life- saving health care services in
geographically isolated and disadvantaged areas. Can function as:
o ECG
o Blood pressure apparatus
o Pulse oximeter
o Fetal heart monitor
eRecords
 Storage of patient’s records online
 Computerized retrieval of patients’ records
 eSurveillance
 Electronic monitoring of health indicators and performance
 Also use for epidemiologic use

JOINT COMMISSION INTERNATIONAL

 The JCI is a medical commission that helps international health-care organizations, public-health
agencies and health ministries evaluate, improve and demonstrate the quality of patient care while at
the same time accommodating specific legal, religious and cultural factors in a particular country.

The Philippine Tripartite Accreditation for Health Facilities, Inc.

 The Philippine Tripartite Accreditation for Health Facilities, Inc. (PTAHF, Inc.) is an independent, non-
profit organization, dedicated to improve and promote quality and safety in the delivery of health care
in the Philippines through continuing review of performance, assessment, and accreditation.

Hospital Accreditation Commission

 HAC, which was established through DOH’s Administrative Order 2013-0002, is the only DOH-
mandated and first PhilHealth-recognized third-party accrediting body in the country.

Joint Commission on Accreditation of Healthcare Organization

 An independent, non-profit organization, JCAHO evaluates and accredits nearly 15,000 healthcare
organizations and programs in the United States.

Important elements of the healthcare system in the Philippines:

 Health Professionals...
 Institutions
 Community Agencies
 Funders (mainly government)
 Industry
 Planning/Coordinating agencies
 The public

Universal Healthcare “Kalusugang Pangkalahatan”

 provision to every Filipino of the highest possible quality of health care that is accessible, efficient,
equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and
empowered public.
R.A.11223 Universal Healthcare Act
 The UHC helps ensure every Filipino is healthy, protected from health hazards and risks, and has
access to affordable, quality, and readily available health services suitable to their needs.

UHC’s Three (3) Strategic Trust

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)