HEALTH CARE

DELIVERY SYSTEM
 The Health Care Delivery System
Introduction:
A Public Health Nurse does not function in a
vacuum. She is a member of a team
working within a system. For the nurse to function
effectively, she has to understandthe health care
delivery system wherein she is working because it
influences her status and functions. She needs to
properly relate with the dynamics of political and
organizational structure surrounding her position
in the health care delivery system
Learning Objectives:
1. Explain how the Department of Health provides
health leadership in the Philippines.
2. List the 2030 Agenda for Sustainable Development.
3. Describe the Philippine health care delivery system in
terms of the different levels of services.
4. Engage in advocacy activities to influence health and
social care service policies
and access to services.
 WORLD HEALTH ORGANIZATION (WHO)
2030 AGENDA FOR SUSTAINABLE
DEVELOPMENT
The SDGs aim to be relevant to all countries –
poor, rich and middle-income – to promote
prosperity while protecting the environment and
tackling climate change. They have a strong
focus on improving equity to meet the needs of
women, children and disadvantaged populations
so that “no one is left behind”.
This agenda builds on the Millennium
Development Goals (MDGs) which were
8 goals that UN Member States signed
in September 2000 to achieve targets to
combat poverty, hunger, disease,
illiteracy, environmental degradation
and discrimination against women by
2015.
B. PHILIPPINE DEPARTMENT OF HEALTH
(DOH)
The Department of Health (DOH) is the
principal health agency in the Philippines. It
is responsible for ensuring access to basic
public health services to all Filipinos through
the provision of quality health care and
regulation of providers of health goods and
services.
Mission- To lead the country in the
development of a productive,resilient,
equitable and people-centered health
system

Vision- Filipinos are among

thehealthiest people in Southeast Asia
by 2022, and Asia by 2040
Roles and Functions
The Department of Health, in its new
roles as the national authority on health
providing technical and other resource
assistance to concerned groups as
mandated by Executive Order 102 has
identified the following general
functions under its three specific roles in
the health sector:
a. Leadership in Health
▪ Serve as the national policy and regulatory institution from
which the local government units, non- government
organizations and other members of the health sector
involved in social welfare and
development will anchor their thrusts and directions for
health.
▪ Provide leadership in the formulation, monitoring and
evaluation of national health policies, plans and programs.
The DOH shall spearhead sectoral planning and policy
formulation and assessment
at the national and regional levels.
▪ Serves as advocate in the adoption of health policies, plan
and programs to address national and sectoral concerns.
b. Enabler and Capacity Builder
▪ Innovate new strategies in health to improve the
effectiveness of health programs, initiate public
discussion on health issues and undertaking and
disseminate policy research outputs to ensure
informed public participation in policy decision-
making.
▪ Exercise oversight functions and monitoring and
evaluation of national health plans, programs and
policies.
▪ Ensure the highest achievable standards of quality
health care, health promotion and health protection
c. Administrator of Specific Services
▪ Manage selected national health facilities and hospitals with modern
and advanced facilities that shall serve as national referral centers;
and, selected health facilities at sub- national levels that are referral
centers for local health systems.

▪ Administer direct services for emergent health concerns that require

new complicated technologies that it deems necessary for public
welfare; administer special components of specific programs as it
will benefit and affect large segments of the population,

▪ Administer health emergency response services, including referral

and networking system for trauma, injuries and catastrophic events,
in cases of epidemic and other widespread danger, upon the
direction of the President in consultation with concerned LGU
LOCAL HEALTH SYSTEM AND DEVOLUTION OF HEALTH
SERVICES
▪ A major shift took place in 1991 with the passage of the
Local Government Code also known as Republic Act 1760.
Under this law, all structures, personnel and budgetary
allocations from the provincial
health level down to the barangays were devolved to the
local government units to facilitate health service delivery.

▪ Devolution made local government executives responsible

to operate local health care services. New centers of
authority for local health services emerged.
Objectives:
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. Promote inter- LGU linkages and cost sharing schemes including
local health care financing systems for better utilization of local
health resources.
4. Foster participation of the private sector, NGOs and communities
in local health systems development.
5. Ensure the quality of health service delivery at the local level.

Inter- Local Health System

▪ This system is being espoused by the DOH in order to ensure
quality of health care services at the local level.
Expected Achievement of the Inter- Local Health System
1. Universal coverage of health insurance
2. Improved quality of hospital and RHU service
3. Effective referral system
4. Integrated planning
5. Appropriate health information system
6. Improved drug management system
7. Developed human resources
8. Effective leadership
9. Financially visible or self- sustaining hospitals
10. Integration of public health and curative hospital
care
11. Strengthened cooperation between LGU and health
sectors
Guiding principles in developing the Inter- Local Health
System
1. Financial and administrative autonomy of the provincial
and municipal
administrations
2. Strong political support
3. Strategic synergies and partnerships
4. Community participation
5. Equity of access to health services by the population
6. Affordability of health services
7. Appropriateness of health programs
8. Decentralized management
9. Sustainability of health initiatives
10. Upholding of standards of equality of service
Composition of Inter- Local Health Zone
1. People- the number of people may vary from zone to zone.
According WHO, the ideal population size of a health district is
between 100, 000 to 500, 000.
2. Boundaries- clear boundaries between Inter- Local Health Zones
determine the accountability and responsibility of health service
providers, geographical locations and access to referral facilities are
the usual basic in forming boundaries.
3. Health Facilities- district or provincial hospitals, RHUs, BHS and
other health services deciding to work together as an integrated
health system.
4. Health Workers- the right unit of health providers is needed to
deliver comprehensive health services.
Philippine Health Care Delivery System

▪ Complex set of organizations interacting to provide an array of

health services

1.Public Sector: Financed through tax- based system

a. National: DOH
b. Local: LGUs

2. Private Sector
a. Profit: Commercial & market oriented
b. Non- Profit: Non- commercial & service oriented
 CLASSIFICATION OF HEALTH FACILITIES

New Classification of Hospitals and Other Health Facilities

Hospitals Other Health Facilities Hospitals Other Health Facilities
GENERAL A. Primary Care Facility
▪ Level 1 B. Custodial Care Facility
▪ Level 2 C. Diagnostic/ Therapeutic
▪ Level 3 (Teaching/ Training) Facility

SPECIALTY D. Specialized Out- Patient

Facility
New Classification of General Hospitals
HOSPITALS LEVEL 1 LEVEL 2 LEVEL 3
Clinical Consulting Level 1 plus all: Level 2 plus all:
Services specialists in:
for Medicine Departmentalized Teaching/
inpatien Pediatrics Clinical Services Training with
OB- GYNE accredited
Surgery residency
training program
in 4 major
clinical services

ER & OPD Respiratory Unit Physical

Services Medicine and
Rehabilitation
Unit

Isolation General ICU Dialysis Clinic

Facilities
Dental Clinic NICU
Ancillary Secondary Tertiary Clinical Tertiary
Services Clinical Laboratory Laboratory with
Laboratory Histopathology
Blood Station Blood Station Blood Bank
1 2 3
st level X- ray nd Level X- ray rd level X- ray
with mobile unit
Pharmacy
New Classification of Other Health Facilities
A B C D
Primary Care Custodial Care Diagnostic/ Specialized OPD
Facility Facility Therapeutic facility
Facility
With in- patient Psychiatric Care Laboratories: Dialysis Clinic
beds: Facility ▪ Clinical (DC)
▪ Infirmary/ Lab/ HIV Ambulatory
Dispensary ▪ Blood Surgical Clinic
▪ Birthing Service (ASC)
Home Facilities
▪ Drug Test
Lab
▪ NB
Screening
Lab
▪ Water
Lab
Without beds: ▪ Drug Abuse Ionizing In- Vitro
Medical OPD clinics ▪ Treatment and Machines as Xray, CT Fertilization
OFW clinics ▪ Dental Rehabilitation Scan, (IVF) Centers
clinics Center Mammography
(DATRC and others

Sanitarium/ Non- ionizing Radiation

Leprosarium Machines as Oncology
Ultrasound, MRI Facilit
and others
Nursing Home Nuclear Medicine Oncology
Center/ Clinic
PHILIPPINE HEALTH AGENDA (2016- 2022) Health Agenda:
All for Health towards Health for All (Lahat Para sa Kalusugan Tungo
sa Kalusugan Para sa Lahat!)

Goals:
1. Financial protection
2. Better health outcomes
3. Responsiveness

Values:
1. Equitable & inclusive to all
2. Transparent & accountable
3. Uses resources efficiently
4. Provides high quality services
Persistent inequities in health outcomes
1. Every year, around 2000 mothers die due to
pregnancy- related complications
2. A Filipino born to the poorest family is 3 times more
likely to not reach his 5th birthday, compared to one
born to the richest family
3. Three out of 10 children are stunted
Restrictive and impoverishing healthcare costs
1. Every year, 1.5 million families are pushed
to poverty due to health care expenditures
2. Filipinos forego or delay care due to
prohibitive and unpredictable user fees or co-
payments
3. Php 4,000/ month healthcare expenses
considered catastrophic for single income
families
Poor quality and undignified care synonymous
with public clinics and hospitals
1.Long wait times
2. Limited autonomy to choose provider
3. Less than hygienic restrooms & lacking
amenities
4. Privacy and confidentiality taken lightly
5. Poor record- keeping
6. Overcrowding & under- provision of care
Ambisyon Natin 2040
1. Universal Health Coverage
2. Strengthen implementation of
RPRH Law
3. War against drugs
4. Additional funds from PAGCOR
3 Guarantees to attain Health- related SDG Targets
1. All Life Stages & Triple Burden of Disease (Services for
both the well &
the sick)
2. Service Delivery Network (Functional Network of
Health Facilities)
Networks should be:
a. Fully functional
b. Compliant with clinical practice guidelines
c. Available 24/7 & even during disasters
d. Practicing gatekeeping
e. Located close to the people
f. Enhanced by telemedicine
3. Universal Health Insurance (Financial Freedom when
Accessing
Services)
Services are financed predominantly by PhilHealth
a. PhilHealth as the gateway to free affordable care
▪ 100% of Filipinos are members
▪ Formal sector premium paid through payroll
▪ Non- formal sector premium paid through tax subsidy
b. Simplify PhilHealth Rules
▪ No balance billing for poor/ basic accommodation & Fixed
copayment for non- basic accommodation
c. PhilHealth as main revenue source for public health care
providers
▪ Expand benefits to cover comprehensive range of services
▪ Contracting networks of providers within SDNs
Strategy- A. C. H. I. E. V. E.
A- Advance quality, health promotion and primary care
1. Conduct annual health visits for all poor families and special
populations (NHTS, IP, PWD, Senior Citizens)
2. Develop an explicit list of primary care entitlements that will
become the basis for licensing and contracting arrangements
3. Transform select DOH hospitals into mega-hospitals with
capabilities for multi-specialty training and teaching and
reference laboratory
4. Support LGUs in advancing pro-health resolutions or
ordinances (e.g. city-wide smoke-free or speed limit ordinances)
5. Establish expert bodies for health promotion and surveillance
and response
C- Cover all Filipinos against health- related financial risk
1. Raise more revenues for health, e.g. impose health promoting
taxes,increase NHIP premium rates, improve premium collection
efficiency.
2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with
PhilHealth
3. Expand PhilHealth benefits to cover outpatient diagnostics,
medicines, blood and blood products aided by health technology
assessment
4. Update costing of current PhilHealth case rates to ensure that it
covers full cost of care and link payment to service quality
5. Enhance and enforce PhilHealth contracting policies for better
viability and sustainability
H- Harness the power of strategic HRH development
1. Revise health professions curriculum to be more primary
care-oriented and responsive to local and global needs
2. Streamline HRH compensation package to incentivize service
in highrisk or GIDA areas
3. Update frontline staffing complement standards from
profession-based to competency-based
4. Make available fully funded scholarships for HRH hailing from
GIDA areas or IP groups
5. Formulate mechanisms for mandatory return of service
schemes for all
heath graduates
I- Invest in eHealth and data for decision making
1. Mandate the use of electronic medical records in all health
facilities
2. Make online submission of clinical, drug dispensing,
administrative and financial records a prerequisite for
registration, licensing and contracting
3. Commission nationwide surveys, streamline information
systems, and support efforts to improve local civil registration
and vital statistics
4. Automate major business processes and invest in warehousing
and business intelligence tools
5. Facilitate ease of access of researchers to available data
E- Enforce standards, accountability and transparency
1. Publish health information that can trigger better performance
andaccountability
2. Set up dedicated performance monitoring unit to track
performance or progress of reforms
V- Value clients and patients, especially the poor,
marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all health programs and
support them in non-direct health expenditures
2. Make all health entitlements simple, explicit and widely published
to facilitate understanding, & generate demand
3. Set up participation and redress mechanisms
4. Reduce turnaround time and improve transparency of processes at
all DOH health facilities
5. Eliminate queuing, guarantee decent accommodation and clean
restrooms in all government hospitals
E- Elicit multi- sectoral and multi- stakeholder support
for health
1. Harness and align the private sector in planning supply side
investments
2. Work with other national government agencies to address
social determinants of health
3. Make health impact assessment and public health
management plan a prerequisite for initiating large-scale, high-
risk infrastructure projects
4. Collaborate with CSOs and other stakeholders on budget
development, monitoring and evaluation
IV. Activity:
1. Research on the current PhilHealth data coverage and
benefits package and take
note of the community health services covered by
PhilHealth. Give at least 3
scenarios wherein you may use this information