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1.

Objectives :

After this one hour oral report the students will be able to learn about the
Philippine Heath Care Delivery System and WHO Sub-National Initiative. Specifically
it aims to:
1. Define Health Care Delivery System.
2. Discuss WHO six building blocks of Health Systems.
3. Explain the Leadership and Governance, Service Delivery, Human Resources,
Medicines and Technologies, Health Financing, and Health Information
System.
4. Relate current programs and trends to the topic.
5. Correlate the WHO Sub-National Initiative to the improvement of the
Philippine Health Care Delivery System.
2.

Comprehensive Content

Health Care Delivery System is the network of health facilities and personnel
which carry out the task of rendering health care to the people.
WHO 6 Building Blocks of Health Systems
1.
2.
3.
4.
5.
6.

Leadership and Governance


Service Delivery
Human Resources
Medicines and Technologies
Health Financing
Health Information System

Leadership and Governance

1.
2.
3.
4.
5.

Devolution refers to the act by which the National Government confers


power and authority upon the various Local Government Units (LGUs) to
perform specific functions and responsibilities.
R.A. 7160 known as the LGU code of 1991- is the legal basis of devolution.
It devolved the following basic services:
Agriculture
Forest management
Health services
Social welfare
Barangay level roads
LGUs were given increased powers to mobilize their resources.
Context of Devolution in the ARMM- It has retained the centralized
character of its health system. DOH ARMM directly runs the provincial
hospitals and municipal health centers.
ILHZ (Inter-Local Health Zones) was inspired by District Health System
(DHS) model of the WHO. It is an integrated health management and
delivery system based on defined administrative and geographical area.

Composed of clusters of adjacent municipalities, usually with similar


health needs, plus other stakeholders.

Figure 1. The Devolution of Health


Health Service Delivery
I.

Key Elements
Organizing health services as networks of primary care backed up by
hospitals and specialized care.
Providing package of health services with clinical and public health
interventions.
Ensuring access and quality of services.
Holding providers accountable for access, quality, and ensuring consumer
voice.
II. Forms of Health Services in the Philippines
Public Sector- it is financed through taxes. Budgeting system is done at the
local and national level. Health services are "free" at the point of care. LGUs
are responsible for the direct delivery of public health services while the DOH
provides technical assistance, capacity building, advisory services for disease
prevention and control, and provides free medicines and vaccines.
Private Sector includes the profit and non-profit health providers. It is
usually market-driven and services are not free usually from out-of-pocket
schemes, insurance, and external fundings.
III. Classification of Health Facilities
According to Ownership Government or Private
According to scope of services General facilities/Hospitals (e.g. Philippine
General Hospital, Jose Reyes Memorial Medical Center), Specialty

Centers/Hospitals (e.g. Philippine Heart Center, National Kidney and


Transplant Institute)
According to functional capacity

Table 1. The New Classification of Health Facilities According to Functionality

Table 2. The New Hospital Categorization/Classification

Table 3. The New Classification of Other Health Facilities

Human Resources
I.

II.

III.

IV.

V.

Key Elements in HRH


Achieving sufficient numbers of the right mix of staf
Ensuring system wide deployment and distribution
Establishing job related norms and enabling work environments
Establishing payment systems that produce the right kind of incentives
Health Providers in the Philippines There are 22 categories of health workers
trained in the Philippines, though some categories do not correspond to
international qualifications.
Trends in Health Personnel The Largest category of health workers in the
Philippines were nurses and midwives. Many newly graduated nurses or
licensed midwives are unable to find employment. There is underproduction
in other categories such as doctors and dentists.
Health Workforce and Distribution There are more hospital-based doctors,
nurses, PTs, and OTs in the private sector than in government. NCR, Regions
III and IV-A have a higher proportion of government health workers than in
other regions in PH.
Career Choices (MDs) Government-based positions are not attractive among
newly-trained MDs due to isolation of other colleagues and perceived lack of

incentives. As of 2008 (DOLE), there are 68% specialist and 32% generalist.
52% are clustered in Metro Manila.
Medicine and Technologies
I.

II.
1.
2.
3.
III.

IV.

Pharmaceutical Care pharmaceuticals reach consumers via a supply-driven


distribution scheme (PHAP, 2008) drugstores 80.1%, hospitals 9 .7%, and
others 10.2 %. Monopolistic pricing exists in hospital drug sales, especially in
private hospitals where outside purchases are discouraged. Drug prices in
hospitals are reported to be double those of prices in retail outlets (DOH,
2008).
Constraints in Accessing Essential Drugs
Limited Availability
Irrational Use
High Costs
Medical Technologies and Devices Bureau of Health Devices and
Technologies of the DOH (BHDT) develops plans, policies, programs and
strategies for regulating health and related-related devices and technology.
Distribution of Medical Devices General Radiography represents the most
basic equipment available across the country. As of 2009, these devices
totalled to 3,860 with 31% found in NCR.

Health Financing
I.

II.

Key Elements
Raising sufficient finds for health
Pooling financial resources across population groups and sharing financial
risks
Using funds for health efficiently and equitably
Health Financing in the Philippines
4.6% of GDP (World Bank, 2012) Global average meanwhile is 10.2%
Low public budget share of health spending (only 7.6% of the total)
Has a high proportion of out-of-pocket spending
Currently fragmented and inequitable

III.

Three Major Groups of Payers of Healthcare in PH


1. Government
2. Social Health Insurance
3. Private Sources

Figure 2. Financial Flows of Health Finance in the Philippines

R.A. 7875 Known as the National Health Insurance Act of 1995.


National Health Insurance Program created the Philippine Health Insurance
Corporation (PHIC) more commonly known as Philhealth.
1. Employed Sector Program compulsory coverage of all employees in
government and private sector.
2. Individually Paying Program voluntary coverage of the self-employed
and others not covered by the rest of the programs.
3. Sponsored Programs covers the "poorest of the poor" segment of the
population (quintiles 1 and 2).
4. Overseas Filipino Workers
5. Lifetime Member Program free for members that have already
completed their 120 monthly contributions.

Health Information
I.

Key Elements in Health Information


Provide timely and quality evidence to inform policy development and
planning, health advocacy and education (feedback).

II.

III.

Make information accessible to all stakeholders.


Maximize the use of information technology for better health services.
Health Information in the Philippines
National and local health information systems are poorly integrated and
are weekly governed (Marcelo, 2005).
Telecom infrastructures are mostly concentrated in cities.
Unclear considerations for the role of IT in primary health care in the
Philippines.
Lack of IT governance structures (explicit standards, etc.).
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 professionals in remote communities or those providing
health care to marginalized and vulnerable groups separated from the
mainstream of socio-economic activities.

eMedicine

Telereferals
RxBox a biomedical device is designed to provide better access to lifesaving health care services in geographically isolated areas (GIDAS). Can
function as: ECG, Blood pressure apparatus, Pulse Oxymeter, Tocometer,
Fetal Heart Monitor.

eRecords

Storage of patients record online


Computerized retrieval of patients records

eSurviellance

Electronic monitoring of health indicators and performance. It is also for


epidemiologic use.

WHO Sub-National Initiative Project Objective

To improve access and utilization of quality maternal, newborn and child


health services amongst the poor in selected sites in Davao region.

WHO Sub-National Initiative

Provides catalytic technical and advisory support to DOH Regional Office


XI and partner Local Government Units to accelerate convergence of
eforts for the health and survival of mothers and newborns, especially
among the most disadvantaged populations.

Key Approaches

Accelerator:

Rapid identification of barriers and bottlenecks of health care to


ensure full implementation.

Governance:

Support to strengthen local health governance and broaden


stakeholder involvement

Level of Interventions

National and Subnational


Support DOH and Regional Health Offices to better perform their
stewardship and TA provider roles
Local
Provincial: Operationalize the Service Delivery Networks to provide a
continuum of quality maternal and child health services.
City/Municipal: Support improvements in local health services, health
system performance, and community outreach

KEY RESULT AREAS

Strengthening health systems support and improving governance for


health (health systems)

Establishing/strengthening Service delivery networks (supply side)

Improving utilization of quality services/ Service provision/ availability by


clients (demand side)

REFERENCES

World Health Organization (2011). The Philippine Health Systems Review.


Cetrangolo, et al. (2013). Health Care in the Philippines: Challenges and Ways
Forward.
Villaverde, M. (2012). Objectives, Functions and Components of Health
Systems (powerpoint slides).
The Local Government Code of 1991 (Republic Act 7160).
Department of Health (2012). Rules and Regulations Governing the New
Classification of Hospitals and Other Health Facilities in the
Philippines (Administrative Order 2012-0012).