The Philippine Health Care Delivery System

HEALTH CARE SYSTEM

• an organized plan of health services (Miller-Keane, 1987)

HEALTH CARE DELIVERY

• rendering health care services to the people (Williams-Tungpalan, 1981).

HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981)

• the network of health facilities and personnel which carries out the task of rendering health care to the people.

PHILIPPINE HEALTH CARE SYSTEM

• is a complex set of organizations interacting to provide an array of health services (Dizon, 1977).

COMPONENTS OF THE HEALTH DELIVERY SYSTEM

The Department of Health Mandate: The Department of Health shall be responsible for the following: formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs; issuance of rules and regulations, licenses and accreditations; promulgation of national health standards, goals, priorities and indicators; development of special health programs and projects and advocacy for legislation on health policies and programs.

The primary function of the Department of Health is the promotion, protection, preservation or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services (E. O. No. 119, Sec. 3). Vision: Health as a right. Health for All Filipinos by the year 2000 and Health in the Hands of the People by the year 2020.

Mission: The mission of the DOH, in partnership with the people to ensure equity, quality and access to health care:

• by making services available
• by arousing community awareness
• by mobilizing resources
• by promoting the means to better health

LEVELS OF HEALTH CARE FACILITIES

1. PRIMARY LEVEL OF HEALTH CARE FACILITIES

• are the rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units operated by the DOH; puericulture centers operated by League of Puericulture Centers; tuberculosis clinics and hospitals of the Philippine Tuberculosis Society;
• private clinics, clinics operated by the Philippine Medical Association; clinics operated by large industrial firms for their employees; community hospitals and health centers operated by the Philippine Medicare Care Commission and other health facilities operated by voluntary religious and civic groups (Williams-Tungpalan, 1981).

2. SECONDARY LEVEL OF HEALTH CARE FACILITIES

• are the smaller, non-departmentalized hospitals including emergency and regional hospitals.
• Services offered to patients with symptomatic stages of disease, which require moderately specialized knowledge and technical resources for adequate treatment.

3. TERTIARY LEVEL OF HEALTH CARE FACILITIES

• are the highly technological and sophisticated services offered by medical centers and large hospitals. These are the specialized national hospitals. Services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge, facilities and personnel to treat effectively (Williams-Tungpalan, 1981)

FACTORS ON THE VARIOUS CATEGORIES OF HEALTH WORKERS AMONG COUNTRIES AND COMMUNITIES

1. available health manpower resources
2. local health needs and problems
3. political and financial feasibility

THREE LEVELS OF PRIMARY HEALTH CARE WORKERS A.

VILLAGE OR GRASSROOT HEALTH WORKERS

• first contacts of the community and initial links of health care.
• Provide simple curative and preventive health care measures promoting healthy environment.
• Participate in activities geared towards the improvement of the socio-economic level of the community like food production program.
• Community health worker, volunteers or traditional birth attendants.

B. INTERMEDIATE LEVEL HEALTH WORKERS

• represent the first source of professional health care attends to health problems beyond the competence of village workers
• provide support to front-line health workers in terms of supervision, training, supplies, and services.
• Medical practitioners, nurses and midwives.

C. FIRST LINE HOSPITAL PERSONNEL

• provide back up health services for cases that require hospitalization
• establish close contact with intermediate level health workers or village health workers.
• Physicians with specialty, nurses, dentist, pharmacists, other health professionals.

TWO-WAY REFERRAL SYSTEM (Niace, et. al. 8th edition 1995)

A two-way referral system need to be established between each level of health facility e. g. barangay health workers refer cases to the rural health team, who in turn refer more serious cases to either the district hospital, then to the provincial, regional or the whole health care system. Public P Barangay Health OHealth Worker Nurse 2nd 3rd P H F H F U E A E A L Barangay RHU A C A C A Health Midwife Physician L I L I T Stations T L T L I H I H I O T T N RHS Sanitary Y Y

Midwife Inspector MULTISECTORAL APPROACH TO HEALTH (NLGNI, 8th edition, 1995)

The level of health of a community is largely the result of a combination of factors. Other health-related Systems (government/ private Ways of CommunityHealth Care The Health System People (Cultural) Environment (Social, Economic, physical, Etc. Health, therefore, cannot work in isolation. Neither can one sector or discipline claim monopoly to the solution of community health problems. Health has now become a multisectoral concern.

For instance, it is unrealistic to expect a malnourished child to substantially gain in weight unless the family’s poverty is alleviated…… In other words, improvement of social and economic conditions need to be attended to first or tackled hand in hand with health problems. 1. Intersectoral Linkages – Primary Health Care forms an integral part of the health system and the over-all social and economic development of the community.

As such, it is necessary to unify health efforts within the health organization itself and with other sectors concerned. It implies the integration of health plans with the plan for the total community development. Sectors most closely related to health include those concerned with: a. Agricultural b. Education c. Public works d. Local governments e. Social Welfare f. Population Control g. Private Sectors

The agricultural sector can contribute much to the social and economic upliftment of the people……. Demonstration to mothers of better techniques and procedures for food preparation and preservation can preserve the nutritive value of local foods. Through joint efforts, agricultural technology that produces side effects unsafe to health (for instance, insecticide poisoning) can be minimized or prevented.

The school has long been recognized as an effective venue for transmission of basic knowledge to the community. Every pupil or student can be tapped for primary health care activities such as sanitation and food production activities….. Construction of safe water supply facilities and better roads can be jointly undertaken by the community with public works. Community organization (e. g. establishing a barangay network for health) can be worked through the local government or community structure.

Likewise, better housing through social welfare agencies, promotion of responsible parenthood through family planning services and increased employment through the private sectors can be joint undertakings for health……We have to recognize that oftentimes health actions undertaken outside the health sector can have health effects much greater than those possible within it. 2. Intrasectoral Linkages – In the health sector, the acceptance of primary health care necessitates the restructuring of the health system to broaden health coverage and make health service available to all.

There is now a widely accepted pyramidal organization that provides levels of services starting with primary health and progressing to specialty care. Primary health care is the hub of the health system.

A PYRAMIDAL HEALTH STRUCTURE

• Tertiary National Health
• Health Care Services
• Regional Health Services
• Secondary Health District
• Health Services
• Care Rural (Local Hospital) Services
• Rural Health Units
• Primary Barangay Health Stations
• Health Care

THE NATIONAL HEALTH PLAN (Niace, et. al 8th edition 1995)

The National Health Plan is the blue print which is followed by the Department of Health. It defines the country’s health problems, policy thrusts, strategies, and targets.

POLICY THRUSTS AND STRATEGIES

There are policy thrusts and strategies which are commonly important. These are:

1. Information, education, and communication programs will be implemented to raise the awareness of the public, including policymakers, program planners and decision-makers;
2. An update of the legislative agenda for health, nutrition and family planning (HNFP), and stronger advocacy for pending HNFP –related legislation will be pursued;
3. Integration of efforts in the health, nutrition and family planning sector to maximize resources in the delivery of services through the establishment of coordinative mechanisms at both the national and local levels;
4. The partnership between the public and the private sectors will be strengthen and institutionalized to effectively utilize and monitor private resources for the sector;
5. Enhancement of the status and role of women as program beneficiaries and program implementers will be pursued to enable them to substantially participate in the development process.