Philippine Health Care SystemPolly T. Chua-Chan, MD, MPH, MHA, FPAFP
SESSION OBJECTIVES:• The student should be able to: - Define Phil Health Care System - Discuss the factors affecting health care system - Describe Phil health care delivery system - Discuss the structure, functions, activities and programs of the Dept. of Health
HEALTH SYSTEM• Interrelated system in which a country organizes available resources for the maintenance and improvement of the health of its citizens and communities.• A health system comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health.
DEFINITION OF TERMSHEALTH CARE SYSTEM• an organized plan of health services (Miller- Keane, 1987)HEALTH CARE DELIVERY• rendering health care services to the people (Williams-Tungpalan, 1981)
DEFINITION OF TERMSHEALTH 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 Context• Health as a basic human right• Department of Health is the lead agency• Local Government Code• Access to health care hampered by high cost, physical and socio-cultural barriers, and health workforce crisis
Devolution• In 1991 the Philippine Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991.• The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units.
Devolution• In 1992, the Philippine Government devolved the management and delivery of health services from the National Department of Health to locally elected provincial, city and municipal governments.
4 Essential Functions of Health System• Service provision• Resource generation• Financing• Stewardship
Health Care System Models• Private enterprise health care• Social security health model• Publicly funded health model• Social health insurance
Private Enterprise Health Care Model• Purely private enterprise health care systems are comparatively rare• Where they exist, it is usually for a comparatively well –off subpopulation in a poorer country with a poorer standard of health care – e.g. private clinics for a small, wealthy expatriate population in an otherwise poor country
Social Security Health Model• Where workers and their families are insured by the state• Refers to social welfare service concerned with social protection, or protection against socially recognized conditions, including poverty, old age, disability, unemployment and others
Publicly Funded Health Care Model• Where the residents of the country are insured by the state• Health care that is financed entirely or in majority part by citizens’ tax payments instead of through private payments made to insurance companies or directly to health care providers
Social Health Insurance• Where the whole population or most of the population is a member of a sickness insurance company• SHI is a method for financing health care costs through a social insurance program based on the collection of funds contributed by individuals, employers and sometimes government subsidies.
Social Health Insurance• Characterized by the presence of sickness funds which usually receive a proportional contribution of their members’ wages. With this insurance contributions these funds pay medical costs of their members• Affiliation to such funds is usually based on professional, geographic, religious, political and/or non partisan criteria
Health Care Utilization• Physical barriers – geographical location patterns of health care consumers in relation to health providers• Financial factors also exists that affect health seeking patterns of the Filipinos
MULTISECTORAL APPROACH TO HEALTH (NLGNI, 8th edition, 1995)• The level of health of a community is largely the result of a combination of factors.• 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.
Health System Composition1. Health sector – refers to the group of services or institutions in the community or country which are concerned with the health protection of the population - may be public (government), private and non-governmental health organizations2. Health –related sectors
Functions of the Health Sector• Direct provision of health services: promotion, prevention, diagnosis and treatment, medical rehabilitation• Development and provision of manpower, drugs and medical supplies; financing support• Research and development• Coordinating, controlling and directing organizations and activities associated with other functions
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
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.
DEPARTMENT OF HEALTH• Principal agency in health in the Philippines• 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• A policy and regulatory body for health
DEPARTMENT OF HEALTH• A technical resource, a catalyzer for health policy and a political sponsor and advocate for health issues in behalf of the health sector• Provides the direction and national plans for health programs and activities
Department of HealthVision:• 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: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
E.O. No. 119, Sec. 3• 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
DOH Offices• The DOH is composed of about 17 central offices, 16 Centers for Health Development located in various regions, 70 hospitals and 4 attached agencies.
Center for Health Development• Responsible for field operations of the Department in its administrative region and for providing catchment area with efficient and effective medical services.• Tasked to implement laws, regulation, policies and programs.• Tasked to coordinate with regional offices of the other Departments, offices and agencies as well as with the local governments.
Center for Health Development• Act as main catalyst and organizer in the ILHZ formation• Provide technical support and advocacy for the dev’t of local health management systems and their integration in the context of the ILHZ• Review and approve ILHZ proposals for funding• Integrate local health plans into regional plans• Undertake monitoring of the development and implementation of ILHS
DOH Hospitals• Provides hospital-based care; specialized or general services, some conduct research on clinical priorities and training hospitals for medical specialization.
Attached Agencies• The Philippine Health Insurance Corporation is implementing the national health insurance law, administers the medicare program for both public and private sectors.• The Dangerous Drugs Board on the other hand, coordinates and manages the dangerous drugs control program.• Philippine Institute of Traditional and Alternative Health Care• Philippine National AIDS Council
District Health System• “A contained segment of the national health system which comprises a well defined administrative and geographic area either rural or urban and all institutions and sectors whose activities contribute to improve health” - World Health Organization
District Health System is subdivided into 3 levels of referral:• Primary – barangay health stations and rural health units• Secondary – district/provincial hospitals• Tertiary – provincial and regional hospitals
1. PRIMARY LEVEL OF HEALTH CARE FACILITIES the rural health units, their sub-centers, chestclinics, malaria eradication units, and schistosomiasiscontrol units operated by the DOH; puericulturecenters operated by League of Puericulture Centers;tuberculosis clinics and hospitals of the PhilippineTuberculosis Society; private clinics, clinics operatedby the Philippine Medical Association; clinicsoperated by large industrial firms for their employees;community hospitals and health centers operated bythe Philippine Medicare Care Commission and otherhealth facilities operated by voluntary religious andcivic 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• 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)
A PYRAMIDAL HEALTH STRUCTURE Tertiary National Health Health Services Care Regional Health Services Secondary District Health Health Services Care Rural (Local Hospital) Services Primary Rural Health Units Health Barangay health Stations Care
Inter Local Health Zone (ILHZ)• Unit of the health system created for local health service management and delivery in the Philippines• Applied in many developing countries where responsibility for health services has been decentralized from national to local health authorities
ILHZ• Has a defined population within a defined geographical area and comprises a central or core referral hospital and a number of primary level facilities such as RHUs and BHS• Clustering of municipalities
ILHZ• Includes all stakeholders involved in the delivery of health services including community-based NGOs and the private sectors (foreign and/or local)• Provides quality, equitable and accessible health care
Composition of ILHZ• People – community members, CHWs, NGOs, people’s organizations, local chief executives, other gov’t officials, private sector• Boundaries – clear boundaries between ILHZ• Health facilities• Health workers – district health team
Importance of establishing an ILHZ• To re-integrate hospital and public health services for a holistic delivery of health services• To identify areas of complementation of the stakeholders – LGUs at all levels, DOH, PHIC, communities, NGOs, private sector and others
Expected achievement of the ILHZ• Universal coverage of health insurance• Improved quality of hospital and RHU services• Effective referral system• Integrated planning• Appropriate health information system
Expected achievement of the ILHZ• Improved drug management• Developed human resources• Effective leadership through inter-LGU cooperation• Financially viable or self-sustaining hospital• Integration of public health and curative hospital
Core Referral Hospital• Main hospital for ILHZ and its catchment population• Main point of referral for hospital services from the community, private medical practitioner and public health services at BHS and RHUs
Core Referral Hospital• Minimum services:• Out-patient services• Lab and radiological diagnostic services• Inpatient care• Surgical services sufficient to provide emergency care for basic life threatening conditions, obstetrics and trauma
Minimum Package of Activity for PHC services• Pre-natal care• Normal delivery and post-partum care• Immunization• Family planning• Nutrition – Vit. A & iron supplementation• Growth monitoring• Control of communicable diseases• Minor surgery – suturing , draining of abscess, circumcision• Dental health• Appropriate referral• Environmental health services
Minimum Package of Activity for PHC services• Basic laboratory services• Health promotion and education• Management of public health services, coordination with NGOs and the private medical sector, participation in ILHZ management• Training of human resources• Supervision of health services and human resources within the municipal catchment area
Complementary Package of Activity for Core Referral Hospitals• Outpatient consultations for patients referred from the primary level• Inpatient medical and surgical care• Emergency room care• Minor surgery (placental extraction, excision, suturing , D&C• Anesthesia• Major emergency surgery (CS, trauma surgery, appendectomy)• Complicated deliveries• Basic orthopedics (ex. Setting of simple fractures
Complementary Package of Activity for Core Referral Hospitals• Nutrition services• Referral of more urgent cases to a higher level of care• X-ray• Laboratory services• Blood transfusion• Pharmacy services• Management of hospital services and participation in ILHZ management• Public health promotion and education• Coordination with public health services• Transport and communication linkages
Tertiary Package of Activity for provincial Gov’t Referral Hospital• Pediatric, surgical, medical, orthopedic obstetric and gynecology departments• Expanded surgical capability (burns)• Intensive care, neonatal intensive care, coronary care• Ophthalmology• Rehabilitative medicine (physiotherapy, occupational therapy)• A full range of dental services• Advanced diagnostics• Public health laboratory (malaria, schistosomiasis, water analysis, referral laboratory of RHUs and core referral hospitals• Blood bank and transfusion services
Tertiary Package of Activity for provincial Gov’t Referral Hospital• Medical social services, veterans, senior citizens medical services• Pharmacy services• Dietary and nutrition services• Wellness center program• Hospital administration and management services• Emergency transport• In-house engineering and maintenance
FACTORS ON THE VARIOUS CATEGORIES OF HEALTH WORKERS AMONG COUNTRIES AND COMMUNITIES1. available health manpower resources2. local health needs and problems3. political and financial feasibility
Philippine Health Human Resource• Labor Force – 34.2 M (42% of the total population)• 8.83% comprise Health Human Resource• Unemployment Rate – 12.7%• 1 out of 5 is underemployed/underpaid
Stock of Filipino Health Workers• Nurses (10,000/year) from 350 nursing colleges• Doctors (2000/year) from 30 medical schools• Midwives (1500/year) from 129 schools• Dentists (2000/year) from 31 dental schools• Pharmacists (1500/year) from 35 pharmacy colleges
Philippine Health Human Resource• Biggest provider of overseas nurses• Underlying reasons affecting nurse recruitment, retention and fast turn-over: - low pay - low morale - insufficient resources - stress - poor job prospect - poor staffing - increase work loads
Comparative Advantage of Filipino Health Workers• Well trained• Highly skilled• Fluent in English• Postgraduate training in the US, Canada, etc.• Competent, caring, compassionate
Philippine Health Human ResourceFactors attributed to the migration of the professionals include:• Weak health systems• Economic need• Professional and career development• Attraction of a better quality life or a higher standard of living
THREE LEVELS OF PRIMARY HEALTH CARE WORKERSA. BARANGAY 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.
Barangay Public 2 F 3 FP Health Health n a r Worker d aO Nurse c d cP H iU H i Barangay RHU e lL Physician e l Health Midwife a iA Station a i l tT l t t yI t y hO RHS Sanitary h Midwife InspectorN
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.
THE NATIONAL HEALTH PLAN• 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 STRATEGIES1. Information, education, and communication programs will be implemented to raise the awareness of the public, including policy makers, 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 legislations 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;•
POLICY THRUSTS AND STRATEGIES4. 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.
Major Influences in the Health Care System• Environmental• Demographic• Socio-cultural• Political• Economic
Other Health- related Systems (gov’t / private) Ways of Health Communitythe People Care Health (Cultural) System Environment (Social, Economic, Physic al, etc)
Factors contributing to the limited capacity of the country’s health care system to deliver better health outcomes• poor health care financing• The inappropriate health service delivery system, where there is excessive reliance on use of high- end hospital services rather than primary care, including an ineffective mechanism for providing public health programs• the brain drain of health professionals
Factors contributing to the limited capacity of the country’s health care system to deliver better health outcomes• the excessively high price of medicines, leading to costly out-of-pocket payments and inadequate and irrational use;• inadequate enforcement of regulatory mechanisms• the insufficient effort expended on prevention and control of new diseases, particularly non- communicable diseases
Factors contributing to the limited capacity of the country’s health care system to deliver better health outcomes• Data adequacy, accuracy and timeliness are other important and perennial issues to be addressed. The unavailability of timely and accurate data/information makes it difficult to make appropriate decisions on policies and programs to improve health care.
ISSUES AND CONCERNS• Some of the major factors affecting the country’s health status are as follows: □inappropriate health delivery system □inadequate regulatory mechanisms and □poor health care financing