Health Care Delivery System 5 Providing administrative and technical leadership in

health care financing and implementing the National

- comprises the entirety of all policies involved about Health Insurance Law.
health, infrastructures, facilities, equipment, products,
human resources, and services that undertake all the Roles as an Enabler and Capacity Builder:
actions involving the health needs, problems and concerns
of all people 1 Providing logistical support to LGUs, private sector, and
other agencies in implementing health programs and
B. PHILIPPINE DEPARTMENT OF HEALTH services;
have direct control and supervision to the regional 2 Serving as the lead agency in health and medical
hospitals, medical centers, and, special and specialty research; and
hospitals. (since 1991, with the Local Government Code or 3 Protecting standards of excellence in the training and
RA 7160)
education of health care providers at all levels of health
provides the Local Government Units or LGUs the
necessary support that they need to manage their own care.
local health system.
Roles as an Administrator of Specific Services:
utilizes their regulatory powers through formulating
policies and standards that are related to health facilities, 1 Serve as administrator of selected health facilities at
health products and health human resources.
subnational levels that act as referral centers for local
Core Values: health systems, that is, tertiary and special hospitals,
1 integrity reference laboratories, training centers, centers for
2 excellence health promotion, centers for disease control and
3 compassion and respect for human dignity prevention, and regulatory offices;
4 commitment 2 Provide specific program components for conditions that
5 professionalism affect large segments of the population, such as
6 teamwork and stewardship of the health of the people
tuberculosis, malaria, schistosomiasis, HIV/AID, and
Vision micronutrient deficiencies;
3 Develop strategies for responding to emerging health
Filipinos are among the healthiest people in Southeast Asia
needs; and
by 2022, and Asia by 2040
4 Provide leadership in health emergency preparedness
A global leader for attaining better health outcomes, and response services, including referral and networking
competitive and responsive health care system, and systems for trauma, injuries, and catastrophic events.
equitable health financing. (2030)
History
Mission
 Before 1898
To lead the country in the development of a productive, only 13 hospitals
resilient, equitable and people-centered health system. created a central board of vaccination
board of health and charity
To guarantee equitable, sustainable and quality health for
medicos titulares or medical officers.
all Filipinos, especially the poor, and to lead the quest for
 1898
excellence in health.
Department of Public Works, Education, and Hygiene
Functions of leadership roles (Executive Order 102, s. Board of Health for the City of Manila
1999):  1899
BOH abolished
1 Planning and formulating policies of health programs registration of births, deaths, and marriages established
and services;  1901
2 Monitoring and evaluating the implementation of health Insular Board of Health
programs, projects, research, training, and services; Provincial and municipal health boards
3 Advocating for health promotion and healthy lifestyles;  1905
4 Serving as a technical authority in disease control and Insular Board of Health abolished
prevention and Bureau of Health was established
 1906  2003
Provincial health boards -> district health officers One-Script systems Improvement Program
 1912 68 hospitals provided with fiscal autonomy
Fajardo Act = consolidated municipalities into sanitary  2005
divisions1915, Bureau of Health was renamed to FOURmula ONE for Health (F1) as blueprint of reform
Philippine Health Service.  2006
 1932 National and international recognitions from the
Office of the Commissioner of Health and Public Welfare Presidential Anti-Graft Commission and Guinness World
 1941 Records Limited.
Department of Health and Public Welfare formalized  2007
 1947 One-stop shop licensure system for hospitals
Department of Health and Public Welfare -> Department sector-wide development approach for health
of Health  2008
 1950 Maternal, Neonatal, Child Health and Nutrition Strategy
second reorganization Universally Accessible Cheaper and Quality Medicines
 1958 Act of 2008
decentralization of health services  2010
creation of eight regional health offices Universal Health Coverage = new platform on health
 1969  2011
passing of the law Philippine Medical Care Act of 1969 = national policy on climate change adaptation
to create the Philippine medical care commission. framework response to terrorism
 1970  2012
the health care service delivery is structured to primary, Sin Tax Reform Law
secondary, and tertiary levels. Responsible Parenthood and Reproductive Health Act
 1972  2013
Department of Health -> Ministry of Health Food Safety Act
+ four regional health offices Malaria Elimination Hubs
 1982  2014
The Integrated Provincial Health Office Graphic Health Warnings Law
Health Education and Manpower Development Service service delivery networks for kalusugan pangkalahatan
 1986 – 1987  2015
Ministry of Health -> Department of Health Universal health Care-High Impact (HI-5) Strategy
+ three regional offices in the NCR, CAR and ARMM, and DOH Academy
national health facilities  2016
 1991 – 1993 Philippine Health Agenda Framework for 2016 – 2022
Office of Health Facilities, Standards, and Regulation entitled, “All for Health towards Health for All”
DOH intensified programs:  2017
Doctors to the Barrios Philippine National Standards for Drinking water of 2017
National Micronutrient Campaign DOH quitline
“Let’s DOH it!”
Local Health Systems and Devolution of Health Services
 1999
Health Sector Reform Agenda (HSRA) of the Philippines Local Government Code or RA 7160’s goal was to enable
National Objectives for Health the local governments in becoming a more responsive,
 2000 accountable, and self-reliant community through a system
HSRA as the major framework for health policies and of devolution or decentralization
investments.
 2001  Devolution – act of the national government into
Guidelines on the HSRA implementation plan + 13 transferring power and authority from the Department
convergence sites. of Health to the Local Government Units – all provincial,
district and municipal hospitals to the provincial
governments and the rural health units or RHUs, and
 barangay health stations or BHs to the municipal 8 All DOH licensed hospitals shall follow A.O. No. 2011-
governments. 0020 on “Streamlining of Licensure and Accreditation of
Hospitals”, A.O. No 2007-0021 regarding “Harmonization
Organizational Structure:
and Streamlining of the Licensure System for Hospitals”,
 Chairman of the board = local executive (Provincial this order and other policy guidelines and/or related
Governor/Mayor) issuances.
 Vice chairman = Provincial/City/Municipal Health Officer 9 All DOH licensed non-hospital based health facilities
 Members subject to the provisions of other Administrative Orders
- chairman of the committee on health of the Sanggunian shall follow the appropriate health facility issuance, this
- representative from the private sector or NGO involved Order and other policy guidelines and/or related
in health service issuances.
- representative of the DOH Classifications of Hospitals
Classification of Health Facilities (DOH AO-0012A) 1 According to Ownership
General Guidelines - Government
- Private
1 All Hospitals DOH licensed will automatically be deemed 2 According to Scope of Services
accredited by PhilHealth as Centers of Safety in - General (Clinical Services, Emergency Services,
accordance with A.O No. 2011-0020, “Streamlining of Outpatient Services, Ancillary and Support
Licensure and Accreditation of Hospitals” Services such as clinical laboratory, imaging
2 Hospitals shall provide the basic hospital functions such facility and pharmacy)
as, but not limited to, acute medical and surgical - Specialty (Treatment of a particular type of illness
services, anesthesia services, emergency medical and or for a particular condition requiring a range of
outpatient services, nursing and dental service, with treatment; Treatment of patients suffering from
common diagnostic and support units such as pathology, disease of a particular organ or groups of organ;
radiology and pharmacy. Treatment of patients belonging to a particular
3 All hospitals and other health care facilities must ensure group such as children, women, elderly and
that infection control and surveillance practices are others)
being followed with strict compliance 3 According to Functional Capacity
4 All hospitals and other health care facilities must also - General Hospital
have complete non-medical services such as, but not Level 1: OR, Post-Op, Maternity, Isolation,
limited to, administrative and finance section, medical Dental, Blood station, Lab, Pharmacy
records section, information management, dietary Level 2: ICU, NICU, HRPU, Respi, X-Ray
services for in-patients, facility management and Level 3: Training, Rehab, Surg, Dialysis, Blood
maintenance, waste management and security services. bank
5 All hospitals and other health care facilities shall - Specialty Hospitals
establish a referral network within their facilities’ vicinity - Trauma Capability Hospitals
to provide for services that they are not capable to
provide. Other Classifications of Hospitals
6 The name of the institution shall be compatible with the 1 Primary Care Facility
functional capacity of the facility. All health facilities = basic services including emergency care and
regulated by the DOH applying for Security and provision for normal deliveries
Exchange Commission (SEC) and/or Department of Trade
and Industry (DTI) registration shall undergo clearance
from Bureau of Health Facilities and Services (BHFS). Two Categories:
7 Owners of health facility shall strictly follow the - With in-patient beds (Infirmary, birthing
standards, criteria and requirements prescribed in the homes)
Assessment Tool for licensure or accreditation of health - Without beds (OPC, OFW clinic, Dental Clinic)
facilities. 2 Custodial Care Facility
= long term care, including basic human
 services like food and shelter to patients with Aspires financial protection, better health outcomes and
chronic or mental illness, patients in need of responsiveness for all Filipinos. 
rehabilitation, people requiring ongoing health
Goals:
and nursing care due to chronic impairments
and reduced degree of independence in 1 Financial Protection
activities of daily living 2 Better Health Outcomes
Examples: 3 Responsiveness
- Custodial Psychiatric Care Facility
- Substance/Drug Abuse Treatment and Values
Rehabilitation Center 1 Equitable and Inclusive to all
- Sanitarium/Leprosarium 2 Transparent and Accountable
- Nursing Home 3 Uses Resources efficiently
3 Diagnostic/Therapeutic Facility 4 Provides high quality services
= examines human body or specimens from the
human body for the diagnosis, sometime Guarantees
treatment of diseases 1 All life Stages and Triple Burden of disease
- Laboratory Facility (Clinical, HIV Testing, Blood 2 Service Delivery Network
Service, Drug Testing, Newborn Screening, - Fully functional with complete equipment, medicines
Drinking Water Analysis) and health professional
- Radiologic Facility (X-ray, CT scan, - Compliant with clinical practice guidelines
Mammography, MRI, ultrasound) - Available 24/7 and even during disasters
- Nuclear Medicine Facility (regulated by PNRI, - Located close to the people
embracing all applications of radioactive - Enhanced by telemedicine
materials in diagnosis, treatment or in 3 Universal Health Insurance
medical research, with exception of used of
sealed radiation sources in radiotherapy) ACHIEVE Strategy
4 Specialized Out-Patient Facility
1 Advance quality, health promotion and primary care
= highly competent and trained staff that
2 Cover all Filipinos against health-related financial risk
performs highly specialized procedures on an
3 Harness the power of strategic HRH development
out-patient basis
4 Invest in eHealth and data for decision-making
Examples:
5 Enforce standards, accountability and transparency
- Dialysis Clinic
6 Value all clients and patients, especially the poor,
- Ambulatory Surgical Clinic
marginalized, and vulnerable
- In-Vitro Fertilization Clinic
7 Elicit multi-sectoral and multi-stakeholder support for
- Stem Cell Facility
health
- Oncology Chemotherapeutic Center/Clinic
1 c
- Radiation Oncology Facility
- Physical Medicine and Rehabilitation
Center/Clinic

Philippine Health Agenda (2010-2022)

released by President Rodrigo Duterte at the beginning of

his term which strengthens the Duterte Health Agenda that
is “All for Health towards Health for All”.
C. PRIMARY HEALTH CARE Health for all Filipinos and Health in the hands of the people
by the year 2020
 Primary Health Care (PHC) – a health care system
adapted by countries in HOPES of providing a universally Mission:
accessible health care system that families in the
to strengthen the health care system by increasing
community will be able to afford and that the country
opportunities and supporting conditions wherein people
will be able to maintain.
will manage their own health care.
Programs under such system are “community-based,
accessible, acceptable, and sustainable” Concept:
Defined by WHO as “essential”
Primary Health Care (PHC) characterized by partnership and
Aims that individuals, families, and community will be
empowerment of people shall permeate as core strategy in
responsible for their health.
effective provision of essential health services
Empowered by involvement and participation of the
community Elements:
– Recognizes the relationship between health and
political, sociocultural, and economic development of 1 Education
the society. 2 Locally Endemic Diseases
3 Essential basic drugs
9 Essential Programs: 4 Maternal and Child Health Care
5 Expanded program of immunization
1 Safe water and good waste disposal
6 Nutrition
2 Treatment and control of communicable and non-
7 Treatment of common diseases
communicable diseases
8 Safe water supply and sanitation
3 Immunization
4 Health Education
9 Prevention and control of leading communicable
5 Treatment of Locally Endemic Diseases
diseases
6 Maternal and Child Health, and Family Planning
10 Promotion of dental health
7 Provision of Essential Drugs
11 Elderly and disabled’s physical and mental health
8 Adequate Food and Proper Nutrition
9 Provision of Medical Care and Emergency Treatment Principles and Strategies:

o then-President Ferdinand E. Marcos signed LOI 949 in 1 Accessibility, acceptability, availability, and affordability
of health services (The 4As of PHC)
1978. Said LOI appointed Hon. Enrique M. Garcia as the
- Health services are delivered where people live and
Minister of Health and tasked the Ministry of Health to
work
create programs that is integrated with other activities
- Development of indigenous or resident volunteer
under the then-national development program of the
health workers to provide health care with an ideal
New Society.
ration of 1:10-20 households
Programs of LOI 949: - Use of low cost, appropriate technology sustainable
by community
1 Strengthened health care delivery system at a primary
- Combined utilization of traditional medicines and
level and immediate support at secondary level
essential drugs (e.g. Botika ng Bayan, Botika ng
2 Develop a strong primary health care system by
Barangay, Ligtas sa Tigdas ang Pinas)
coordinating with other Ministries and agencies
3 Lowered costs of drugs
4 Rotation and increase in medical personnel
2 Partnership between community and health agencies in
5 Strengthen and reorient established programs for
provision of quality, basic and essential health services
family-planning, nutrition, malaria eradication, etc.
- Community needs and priorities are basic for
6 Develop a way to eradicate tuberculosis
planning health services and activities
7 Strengthen staff function and capabilities
- Training curriculum of community health workers I
Goal: based on community health problem and task
analysis of community health workers
 - Regular supervision and periodic evaluation of o Inter-sectoral linkages – health is a multi-sectoral
community health workers’ performance by health concern and not primarily economic in orientation.
staff to community It is the collaboration between health sector and
- Development of promotive, preventive, curative and other departments of society. (e.g. Rabies
rehabilitative care Prevention and Control Programs – with inclusion of
- Recognition of role and traditional healers in delivery DOH for immunization, DA for rabies immunization
of health services for dogs, and DepED with LGU for information
campaign in schools and communities.)
3 Community Participation
- Awareness building and consciousness raising on health 9 Equitable distribution of health resources
and developmental issues Philippines has an overproduction of health care workers
- Community building and organizing (nurses, doctors) that tend to work in the urban areas
- Planning, implementation, monitoring and evaluation rather than to the rural. As National Statistical
done by community Coordination Board stated, 29% of doctors and 26% of
- Community discussions done through small group nurses are employed by the Philippine government. Due
discussions to this trend, DOH made two programs to guarantee
- Selection of community health workers by community equitable distribution of health resources.
- Foundation of health committees
o Doctor to the Barriors (DTTB) Program – the
- Establishment of community health organizations
- Mass health campaigns and community mobilization deployment of doctors to areas with minimal health
care assistance. They aim to manage economically
4 Self-reliance suppressed fifth- or sixth-class municipalities, and
- Community generates support for health care unserved RHU or health centers.
- Mobilization of health resources o RN HEALS (Registered Nurses Health Enhancement
- Training of community leaders on leadership and and Local Service) –a training and deployment
managerial skills program for unemployed nurses to address the
- Income-generating projects insufficient workforce of nursing in rural areas and
health communities.
5 Recognition of interrelation of health and development
- Convergence of health, food, nutrition, water, 10 Appropriate technology (“applied science”)
sanitation and population services
- Integration of PHC into national, provincial, municipal o Safety
and barangay development plan o Effectiveness
o Affordability
6 Social Mobilization o Simplicity
- Establishment of effective health referral system o Acceptability
- Multi-sectoral and inter-disciplinary linkages o Feasibility and reliability
- Integration, Education, Communication (IEC) support o Ecological effects
using multimedia channels
o Potential to contribute to individual and community
- Collaboration among government agencies, non-
development
government organizations and community groups

7 Decentralization
- Reallocation of budgetary resources
- Advocacy for political will and support
D.LEVELS OF PREVENTION
- Re-orientation of health
 Prevention, when connected to health, is really about
8 Multi-sectoral approach
avoiding the disease before it starts. Prevention is either
o Intra-sectoral linkages – communication and the plans or measurements taken to prevent the start of
collaboration within the health sector: among the a disease or other health problem before it proceeds to
members and among the health agencies. (e.g. RHU an undesirable health casualty. The level of prevention
as two-way referral system) also helps
Level I: Primary prevention Purpose:

Primary preventions are the preventive measures that Secondary prevention aims to identify individuals in an early
prevent onset of illness or injury right before the disease stage of a disease process and to limit further disability.
process begins. It is applied to general healthy individuals
Level III: Tertiary Prevention
and/or groups and focuses on:
Tertiary prevention measures begin after an illness and aims
o Health Promotion
to retain, re-educate and rehabilitate people who have
o Protection against specific health problems
already developed an impairment or disability. It happens
Examples: when a defect or disability is fixed, stabilized, or determined
to be irreversible.
o Health education
- Injury and poisoning prevention Examples:
- Standards of nutrition and of growth and
o Referring a client who has had a colostomy to a
development for each stage of life
support group
- Exercise requirements
o Teaching a client who has diabetes to identify and
- Stress management
prevent complications
- Protection against occupational hazards
o Referring a client who has been in coma for months
o Immunizations
to a rehabilitation center to receive training that
o Risk assessments for specific disease
will maximize use of remaining abilities.
o Environmental sanitation and provision of adequate
housing, recreation, and work conditions Goals:

Purpose: 1 To help the patient go back to his state of health

2 Helps the patient to live independently as soon as
Primary prevention aims to decrease the risk or exposure of
possible with maximization of one’s potential
the individual or community to disease.
3 Enhance quality of life of patient (End of life care,
Level II: Secondary prevention Pain management, Care of the death and dying)

Secondary prevention measures lead to early diagnosis, Purpose:

prompt intervention, and health maintenance for
Tertiary prevention aims to focus on restoration and
individuals experiencing illness or injury. This also includes
rehabilitation with the goal of returning the individual to an
preventions of more severe problems that are still
optimal level of functioning.
developing. Focuses on:
A client may have experienced a heart attack, and a goal of
o Early identification of health problems and;
secondary prevention is to limit disability. The teaching
o Prompt intervention to alleviate health problems (e.g., lifestyle changes) for the client’s rehabilitation will be
Examples: similar to health education activities in primary prevention.

o Different diagnostic procedures

- X-ray procedure
- CT Scan (Computerized Tomography)
- MRI (Magnetic Resonance Imaging)
- Bone Scan
E. UNIVERSAL HEALTH CARE (UHC)
- ECG (Electrocardiogram)
- PET Scan (Positron Emission Testing Scan) o "Kalusugan Pangkalahatan"
o Laboratory Workups o Formerly known as Aquino Health Agenda
- Complete Blood Count o Latest health sector reforms
- Treatment (Surgery, Chemotherapy, o Built upon the strategies of two previous platforms of
Radiotherapy) reform:
- Urinalysis - Health Sector Reform Agenda (1999-2004)
- Stool exam - FOURmula One (F1) for Health (2005-2010)
o UHC is planned for implementation until 2016 (DOH, 2 Ensure that all Filipinos are guaranteed equitable access
2010) to quality and affordable health care goods and services,
and protected against financial risk
Legal Basis
Strategic Thrusts:
On December 10, 2018, the Senate and the House of
Representatives passed the Senate Bill 1896 in 1. Philhealth will be renamed Philippine Health Security
consolidation with the House Bill No. 5784, the Universal Corporation
Health Care (UHC) under the Republic Act 11223, “An Act
This will emphasize the agency’s role in providing financial
Instituting Universal Healthcare for All Filipinos, Prescribing
security in health rather than just helping people pay for
Reforms in the HealthCare System, and Appropriating Funds
health services. With this reform, the agency will provide
Therefor”.
uniform benefits for all; develop a single but comprehensive
Background and Rationale primary care package (include medicines) for all; create
supplementary coverage by HMOs and private health
It is the policy of the state to protect and promote the right
insurance; provide network-based licensing, contracting, &
to health of all Filipino and instill health consciousness
accreditation of facilities.
among them. The state shall adopt:
Ultimately, the end service will be to ensure No Balance
o An integrated and comprehensive approach to
Billing (NBB) for the non-formal members or ward
ensure that all Filipinos are health literate, provided admissions and fixed co-payment for formal sector
with healthy living conditions, and protected from members or private room accommodation.
hazards and risks that could affect their health;
o A healthcare model that provides all Filipinos access For Filipinos to take advantage of these benefits, eligibility
to a comprehensive set of quality and cost effective, will be through automatic inclusion to the National Health
promotive, preventive, curative, rehabilitative and Security Program.
palliative health services without causing financial
2. Simplified membership
hardship, and prioritizes the needs of the
population who cannot afford such services; PhilHealth members will be identified into two (2) groups:
o A framework that fosters the whole-of-system,
 Direct contributors – Paying members who are by
whole-of-government, and whole-of-society
default deducted for the premium through their
approach in the development, implementation,
payroll.
monitoring, and evaluation of health policies,
programs and plans;  Indirect contributors (non-contributors) – Non-
o A people-oriented approach for the delivery of paying members, basically everyone who isn’t a
health services that is centered on people's needs member of Philhealth. This will be fully subsidized
and well-being, and cognizant of differences in premium from tax collections.
culture, values and beliefs.
3. National Health Insurance Program (NHIP)

The Universal Healthcare Bill will basically pave the way to

the National Health Insurance Program. The NHIP will
oversee the entire process to ensure that every member is
granted immediate eligibility for the health benefits
package.

Objectives and Thrusts 4. Population and individual-based healthcare initiatives

Goals and Objectives: This law will utilize the different agencies to deliver
different healthcare services according to their classified
1 Progressively realize universal health care in the country
scope or function: population or individual healthcare
through a systemic approach and clear delineation of
services.
roles of key agencies and stakeholders towards better
performance in the health system, and; Department of Health (DOH)
o To conduct population-based health interventions.
o Their main role is to finance population-based services,
set standards and integrate a whole-of-society as well as
whole-of-government approach.
o Their tasks include delivery of health interventions to the
community as a whole like community healthcare
programs such as vaccination and medical missions,
health awareness campaigns, and basically streamline
the delivery process and standards to all community-
based healthcare service providers (community health
centers and hospitals).
o Improve the doctor-to-patient ratio and increase the
number of hospital beds and equipment. It also calls for
the establishment of hospitals in remote areas.

Philhealth

o Focused on individual-based health interventions.

o Their main role is to finance all individual-based level
services as a single, national purchaser
o Scope includes delivery of the following but not limited
to individual hospitalization, rehabilitation, and
emergency healthcare provision.
o The amount of provision will be determined through a
fair and transparent technology assessment process.
o Individual-based health services will be financed
primarily through prepayment mechanisms such as
social health insurance, private health insurance, and
HMO plans to ensure predictability of health
expenditure.