Realities of the Health System

Primary Health Care Health Services Organization and Governance

• Poor leadership and governance on health of chief
- An approach through which essential health care
services are made universally accessible to executives
individuals and families in the community by means • No explicit policy consensus on equity and health
acceptable to them, through their full participation • Top-down policy making and implementation
and at a cost that the community and country can mechanisms
afford • Fragmentation of health system
- It forms an integral part of the country s health o Public/Private segregation
system of which it is the nucleus. o Over-specialization
- It is also an essential component of the over-all o Discontinuities between levels of care
social and economic development of the community o Geographic disparities in quality and quantity
or country. of services
Health Human Resources
Health
• Poorly motivated ‒ high income expectations
- State of complete physical, mental and social well-
• Inappropriately trained
being and not merely the absence of disease or
- skills for high technology, developed country
infirmity.
setting
Defining Inequities - training for export
• Inequities ‒ differences in the availability of • Irrationally deployed
opportunities to access health and other social - Urban, high end concentration
services of different individuals Health Information System
• In an inequitable society, individuals have varying • Outdated data collection
access to social services necessary for better • Explosion of Information and Communications
outcomes and improved quality of life. Technology
The State of Health of the Poor - expanded roles of health managers and
• Every year, around 2000 mothers die due to providers
pregnancy-related complications. • Non-standardized and uncoordinated use of
• A Filipino child born to the poorest family is 3 times Information Technology
more likely to not reach his 5th birthday, compared Access to Essential Medicines
to one born to the richest family. • Less than 30 percent of the population has regular
• Three out of ten children are stunted. access to essential drugs
• 40% of the population cannot afford to buy the
Behind the Numbers ‒ Access to Health and Social
medicines they need
Factors
• Problem of rational drug use ‒ thousands of
• Lower preventable deaths
pharmaceutical products sold under different brand
• Better health outcomes
names, doses and preparations
• More access to doctors and advanced health
facilities Poor quality and undignified care synonymous with
• Higher knowledge of and compliance to health public clinics and hospitals
education • Long wait times
• Reproductive health demands are satisfied • Limited autonomy to choose provider
• Highest number of preventable deaths • Less than hygienic restrooms lacking amenities
• Poor health outcomes • Privacy and confidentiality taken lightly
• Less access to doctors with higher use of public • Poor record-keeping
health facilities • Overcrowding and under-provision of care
• Poor knowledge and compliance on health needs
• High unmet RH needs Primary Health Care History
Alma Ata Declarations as foundation of PHC
Health Realities of the Poor Session Outline
1. Health is a fundamental human right.
Restrictive and Impoverishing Healthcare Costs
2. There is a global burden of health inequities.
• Every year, 1.5 million families are pushed to poverty
3. Economic and social development is of basic
due to health care expenditures
importance for the full attainment of health for all.
• Filipinos forego or delay care due to prohibitive and
4. Government have a responsibility for the health of
unpredictable user fees or co-payments
their people.
• Php 4000/month health care expenses considered
catastrophic for single income families Goal of PHC
• Improved state of health and quality of life for all
people attained through self-reliance.
• "Health in the hands of the people by the year 2020"
Objectives of Primary Health Care Participatory Approach VS. Directive
1. Favorable population growth and structure. A. Participatory Approach
2. Reduction in morbidity and mortality rates. • Members have sense of ownership
3. Reduction in the prevalence of preventable • Commitment is to long-term change
communicable diseases & other diseases. • Increased strength and longevity of change
4. Improvement in basic sanitation. • Community is involved in problem solving
5. Development of the capability of the community B. Directive Approach ‒ Appropriate
6. Maximization of the contribution of all sectors to the • Appropriate in emergency situations when
social and economic development of the community. immediate resolutions to problems are
necessary
Elements of Primary Health Care
• Community
E ‒ Education for health
o Change process is imposed on the
L - Locally endemic disease control
community by outside forces
E ‒ Expanded program of Immunization
o Change is rapid
M ‒ Maternal and Child Health
o There is no community ownership
E ‒ Essential Drugs
o Change is short lived
N ‒ Nutrition
T ‒ Treatment of communicable diseases Advantages / Benefits of Community Participation
S ‒ Safe Water and Sanitation 1. Increases community self- reliance
2. Improves the availability and wise use of resources
Principles of Primary Health Care
3. Facilitates long-term behavioral change
1. Health and development are interrelated.
4. Encourages government support
2. Essential health services must be accessible,
5. Promotes service that is culturally acceptable
available, acceptable, affordable.
3. It focuses on primary prevention and equitable PHC utilizes appropriate technology
distribution of health resources. • Technology - procedures/techniques/ methods,
4. PHC uses support mechanism through the multi- tools, drugs, equipment, etc... used to deliver health
sectoral approach. services.
5. PHC requires genuine people s participation.
Criteria for appropriate health technology
6. PHC requires the use of appropriate technology.
• Safety- no risk to the user or very minimal
• Effectiveness- accomplishes its purpose
Interrelationship between Health, Development, and
• Affordability
Poverty
• Simplicity - requires simple materials available
• Acceptability
• Feasibility and reliability - easy to use in the settings
where it will be used
• Ecological effects - does not destroy the
environment
• Potential to contribute to individual and community
development- promotes self-sufficiency

Alternative & complementary

Therapies
Acupressure
- involves application of pressure along the
(points) meridians.
- removes blockages and restores body energy
balance.
Acupuncture
- involves insertion of needles to points
Chiropractice
- uses manipulation to correct disordered joints,
especially those of the spine.
- based on fact that nervous system controls the
function of every cell, organ, and system of the
body.
Hypnotherapy
- Patient is pulled into a deep state of relaxation then
therapist put forth positive suggestions
Reflexology Sambong (Camphor)
- Involves pressing of the reflex points on the foot - A plant that reaches 1.5 to 3 meters high with
- Very relaxing rough hairy leaves.
- Improves energy flow (Qi) - Uses:
o Diuretic/anti-edema, anti-urolithiasis
Reike
Note: not a medicine for kidney infection
- Channels universal life energy to the recipient to
promote spiritual, mental and physical well-being Tsaang gubat
- Conducted through series of gentle touch patterns - A shrub with small, shiny nice-looking leaves that
grows in uncultivated areas and forests
Yoga
- Uses: Diarrhea, stomachache
- Unites the mind, body, and spirit
- Includes variety of moving and static poses and Niyug-Niyogan (Chinese Honey Suckle)
stretched, breathing exercises, meditation, and - Vine which bears tiny fruits
diet. - Uses: anti-helmintic
- Relieves tension and stress
Bayabas (Guavas)
Psychic/Spiritual Healing - Uses: washing of wounds, Diarrhea, gargle to
- The use of psychic energies to heal another person relieve toothache
- Generally associated with religious practices.
Akapulko (ringworm bush or shrub)
Aromatherapy - Uses: Tinea Flava, Ringworm, athletes foot, scabies
- Use of essential oils for health promotion and
Ulasimang Bato
treatment
- A weed with heart-shaped leaves
- Oils can be massaged, inhaled or added to water
- Uses: lowers uric acid (gout)
bath.
Bawang (Garlic)
Herbalism
- Uses: Lowers cholesterol level, HPN, Toothache
- Use of herbs to prevent, treat illness, and
Note: Take on a full stomach to prevent ulcers
restore balance
Ampalaya (Bitter gourd)
Herbal Plants Recommended for - Uses: mild, non-insulin dependent DM

Use by Department of Health (DOH) Summary:

Lagundi (5 Leaves Chaste Tree)
- A shrub that grows wild in vacant lots and waste Primary Care VS Primary Health Care
land. The flowers are blue and bell-shaped. Leaves
- Health services - Overarching
are best collected when flowers are in bloom
- First level of approach and
- Uses:
contact (health philosophy in health
o Asthma
facility or system
o Fever
provider) with transformation
o Skin disease
the health anchored on social
o Rheumatism
system values
o Confusion
- Foundation where
o Cough
health systems
o Dysentery
should be built on
o Headache
o Sprain PHC vs. Traditional approach
o Insect bites
Yerba (Hierba) Buena (Peppermint)
- A small multi-branching aromatic herb. The leaves
are small, elliptical and with toothed margin.
- Uses:
o Headache
o stomachache
o Rheumatism & arthritis
o cough and cold
o swollen gums
o toothache
o Menstrual, gas pain &nausea
o Fainting
o insect bites & pruritus
 WHO Core Functions
The Philippine health care delivery • Providing leadership on matters critical to health;
engaging in partnerships
system • Shaping
translation,
the
and
research agenda
dissemination of
(generation,
valuable
Health System
knowledge)
- Includes all organizations, people, facilities, and
• Setting norms and standards and promoting and
actions/approaches/services with a primary intent
monitoring their implementation (health programs)
of promoting, restoring, and maintaining health.
• Articulating ethical and evidence-based policy
- 6 building blocks (components):
options
1. Service delivery
• Providing technical support, catalyzing change, and
- The actual services, commodities and
building sustainable institutional capacity; offers
programs delivered to the communities
training in the implementation of major programs,
2. Human resource for health
monitoring of health situation/ health trends
- All human resources for health, from
• WHO has always been a partner of the Philippine
medical professional to community
DOH in meeting the MDGs and in navigating the
volunteers (BHWs, BNSs, IT and admin.
SDGs.
aides in health facilities, etc.)
3. Health information
MDGs (attained ‒ 2015)
- Production, analysis, dissemination and
• Eradication of poverty and hunger
use of reliable and timely information on
• Achieve universal primary education
health
• Promote gender equality and empowerment
4. Technologies (health products, vaccines,
• Reduce child mortality
etc.)
• Improve maternal health
- Medicines, supplies and equipment used in
• Combat AIDS, malaria, and other major CDs
the delivery of health services
• Ensure environmental sustainability
5. Health financing
• Develop a global partnership for development
- Adequate funds allocated for health
system operations including health
Note: 3 are strictly health issues; 5 are health-related
insurance (ex. Philhealth, PCSO, national
issues.
budget)
6. Leadership and governance for health
Health and the SDGs Key Area
(stewardship)
The WHO report presents the latest data and in-depth
- Local executives; ensuring strategic policy
analysis for the key areas outlined in the health SDGs:
frameworks, oversight of and coalition-
• reproductive, maternal, newborn, child and
building for the health system; initiation of
adolescent health;
linkages with stakeholders.
• infectious diseases including HIV, tuberculosis,
malaria, hepatitis and neglected tropical diseases;
• Non-communicable diseases (NCDs) including heart
disease, cancer and diabetes;
• mental health and substance use including narcotics
and harmful use of alcohol;
• injuries and violence; and
• universal health coverage.

Department of health (DOH)

Vision and Mission
Vision
- a global leader for attaining better health
World Health Organization (WHO) outcomes, competitive and responsive health
• global health organization care system, and equitable health financing.
• Brainchild of UN Diplomats Mission
• Officially established in April 7,1948 - to guarantee equitable, sustainable and quality
• April 7- World Health Day health for all Filipinos, especially the poor, and to
• Headquarters in Geneva, Switzerland lead the quest for excellence in health.
• Provides global leadership in matters of health
• Goal: The attainment of the highest level of health DOH Functions
by all peoples • Planning and formulating policies of health
programs and services
• Monitoring and evaluating the implementation of the
health programs, projects, research, training, and
services
• Advocating for health promotion and healthy
lifestyles
• Serving as a technical authority in disease control
and prevention
• Providing administrative and technical leadership in
the health care financing and implementing the
National Health Insurance Law
• Other functions (refer to textbook):
- enabler/ capacity builder
- administrator of specific services like
providing leadership in health emergency
preparedness and response services

Local Health System

• For over forty years, the Philippine Health System
was administered by a central agency in Manila. This
control agency provided the singular sources of
resources, policy direction, technical and
administrative supervision to all health facilities
nationwide.
• Major shift took place in 1991 with the passage of
Local Government Code known as RA 7160.

RA 7160
• The law provides that all structures, personnel, and
budgetary allocations from the provincial health
level down to the barangay were devolved to the
local government units to facilitate health service
delivery.
• Devolution made local government executives
responsible to operate local health care services.

Inter-local Health System

• It is a system of health care in which individuals,
communities, and all other health care providers in
a well-defined geographical area participate in
providing quality equitable and accessible health
care.

Expected Achievement of Inter-Local Health

System
1. Universal coverage of health insurance
2. Improved quality of hospital & RHU service
3. Effective referral system
4. Integrated planning
5. Improved drug management system
6. Developed human resources
7. Effective leadership
8. Financially visible or self-sustaining hospitals
9. Integration of public health and curative hospital
care
10. Strengthened cooperation between LGU and health
sectors